Risk Adjustment and Clinical Documentation Improvement—A Partnership in Quality

Activity description

This second module in the APC Coding Series will provide advanced practice physicians with an overview of the value and importance of accurately documenting the chronic medical conditions of patients enrolled in CMS’s Medicare Advantage program (Medicare Part C). It will discuss why health plans must provide CMS with accurate and specific documentation and coding, and the impact of these on patients’ risk scores, and the management of their conditions. The role of clinical documentation improvement (CDI) practices in promoting quality documentation that supports the necessity of medical services will also be discussed.

Provided by
This activity is provided by Optum Health Education and Optum, Clinical Performance.

Commercial support
No commercial support was received for this activity.

Required hardware/software
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Target Audience

This activity is designed to meet the educational needs of nurses, nurse practitioners, PAs, physicians and other health care professionals (HCPs) who are interested in learning about improving clinical documentation practices and the important role of accurate ICD-10-CM coding in providing quality patient care.

Learning Objectives

At the end of this activity, participants should be able to:

  • Describe CMS’s Medicare Advantage program (Medicare Part C) and explain why CMS requires health plans to report accurate documentation related to chronic medical conditions.
  • Identify how accurate documentation can affect a patient’s risk score and positively impact patient care.
  • Recognize the purpose of clinical documentation improvement (CDI) practices and key elements of quality documentation.
Activity summary
Available credit: 
  • 1.00 AMA - Physicians
  • 1.00 ANCC - Nurses
  • 1.00 Attendance - General Attendance
Activity opens: 
Activity expires: 

Sr. Coding & Documentation Integrity Educator 
Coding Operations-Home and Community | Learning & Development
Risk Adjustment Center of Excellence | Optum Health

About the presenter
Gayle Haas, MSEd, MSHI, RHIT, CCS, CPC-Instructor, CPC, CRC is an Optum Senior Instructional Designer/Senior Documentation and Coding Integrity Educator for Home and Community Coding Operations, Learning and Development team. Gayle has a  Master’s degree in Education: Instructional design for online learner’s and a Master’s degree in Health Information Technology. She has 26 years’ experience as an ICD-10 Coding Educator and holds credentials with the following designations: Registered health information technician (RHIT); Certified coding specialist (CCS); Certified coding professional (CPC),  Certified coding profession-instructor (CPC-I) and Certified risk adjustment coder (CRC). Gayle is also an adjunct professor at Bryant & Stratton College online. Gayle enjoys helping others understand how to code using ICD-10 and to understand the how’s and why’s behind the codes. Outside of work her interests are genealogy, crafts, and sightseeing Florida! Gayle’s family consist of two daughters, one son-in-law who calls her “mom” and a grandson who is almost two. Also, her family includes a much-loved dog who is a Whippet and Rat Terrier mix called Bunny. (He’s all ears!)

Activity planners
Elizabeth Albert, MD
Clinical Activity Manager
OptumHealth Education

Chelly Hartge, LPN, RHIA, CCS, CRC, CCDS-O
Associate Director Learning & Development
Coding Operations-Home and Community
Risk Adjustment Center of Excellence | Optum Health

Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, Optum Health Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.

The activity faculty and planners have no financial relationships to disclose.

Method for calculating CE credit
CE credit was calculated by the complexity of content.

Accreditation statement
Joint Provider LogoIn support of improving patient care, this activity has been planned and implemented by Optum Health Education and Optum, Clinical Performance. Optum Health Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Credit designation statements
The participant will be awarded up to 1.00 contact hour(s) of credit for attendance and completion of supplemental materials.

Nurse practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.

Optum Health Education designates this enduring activity for a maximum of 1.00 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.

A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been preapproved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization from which they wish to obtain credit.

Available Credit

  • 1.00 AMA - Physicians
  • 1.00 ANCC - Nurses
  • 1.00 Attendance - General Attendance
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