Quality and Risk Workshop

Las Vegas, NV US
January 22, 2020

Activity description

It is well known that patients with multiple serious medical conditions have higher costs of care and require more resources. In a typical fee-for-service model there are limited mechanisms to recognize and address these discrepancies. Risk Adjustment is a model that adjusts reimbursement based on the presence or absence of serious medical conditions such as diabetes or heart failure. Over time, more accurate coding results in more accurate reimbursement. As we continue to evolve the health care system to a more closely aligned fee-for-value model, risk adjustment plays a key role and has the potential to truly align resources and care.

This activity will review the basics of the risk adjustment system in Medicare and how accurate and appropriate diagnosis, documentation, coding, and care lead to improved patient benefits, such as transportation, and lower copays—as well as improved reimbursement for health plans and providers. The activity will move from an overview to a condition-focused review.

    Provided By
    This activity is provided by OptumHealth Education.

    Commercial Support
    This activity is supported by Optum—Collaborative Care.

    Hardware/Software Requirements
    To view this activity you will need Internet Explorer 7.0+ or Firefox 3.0+ with Windows Media Player 9+, RealPlayer 12+, or Adobe Flash Player 9+. Be sure to disable your pop-up blocking software prior to the beginning of this activity.

    Target Audience

    These materials are intended only for those that attend the live activity on Wednesday, January 22, 2020.  This activity is designed to meet the educational needs of physicians—including family physicians—and other health care professionals who have an interest in health care economics and risk adjustment.

    Learning Objectives

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

    1. Identify how risk adjustment provides an opportunity to align care across the health care delivery spectrum
    2. Understand how accurate and appropriate risk adjustment leads to sufficient resources to increase patient benefits
    3. Explain why medical practices should improve their documentation in response to the transition from fee for service to fee for value
    4. Describe how to follow disease improvement or progression using ICD-10 codes reflecting the patient’s condition
    5. Discuss how ICD-10 codes may be used in the pay-for-performance program
    6. Discuss the level of detail required by the new system and how to improve accuracy and specificity in documentation
    Activity summary
    Available credit: 
    • 12.00 AMA - Physicians
    • 12.00 Attendance - General Attendance
    Activity opens: 
    Activity expires: 
    Event starts: 
    01/22/2020 - 9:00am EST
    Event ends: 
    01/22/2020 - 4:00pm EST
    OptumCare Community Center (formerly known as the Lifestyle Center-East)
    5820 South Eastern Avenue
    Suite 100
    Las Vegas, NV 89119
    United States

    Faculty Listing
    Nikki Macalalad, MSN, APRN, FNP-C
    Associate Director of Clinical Coding Education, CDQI
    Southwest Medical Associates--part of OptumCare
    Las Vegas, Nevada

    Disclosures of Relevant Financial Relationships
    In accordance with the ACCME Standards for Commercial SupportSM, OptumHealth Education requires all those involved in the development of activity content to disclose their relevant financial relationships. An individual has a relevant financial relationship if such person (or their spouse/partner) has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the activity content over which the individual has control.
    OptumHealth Education ensures that the content is independent of commercial bias.

    Faculty Disclosure
    Ms. Macalalad reported that she has no relevant financial relationships.

    Activity Planners
    Kevin Heath, MD, MHL, FACP
    National Medical Director for Education Solutions
    Clinical Performance, OptumCare

    Tania Miedico, MD
    Medical Director

    Sarah Chart, RN
    Senior Director
    OptumHealth Education

    Rebecca Gleason, RN, CCM
    Activity Manager
    OptumHealth Education

    V. Silverstein, MD
    Eagle Creek Medical Communications
    Durham, North Carolina

    Activity Planner Disclosures
    Ms. Chart and Ms. Gleason reported that they are employees of and own stock in UnitedHealth Group.
    Dr. Heath, Dr. Miedico and Dr. Silverstein reported that they have no relevant financial relationships.

    Accreditation Statement
    Joint Accreditation Logo In support of improving patient care, OptumHealth 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

    OptumHealth Education designates this live activity for a maximum of 12.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    American Academy of Family Physicians
    This Live activity, Quality and Risk Workshop, from 10/02/2019 - 10/02/2020, has been reviewed and is acceptable for up to 12.00 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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

    AAPC-Certified Coders
    AAPC will honor 1-for-1 CEUs for any live event offering CME credit or AMA PRA Category 1 Credit™. A certificate of attendance or completion is necessary to show participation. The certificate will give the total CMEs possible for the offering. Physicians are advised to claim only the actual hours that they were present during the education. We ask that AAPC-certified members abide by this request also. One hour of instruction is worth 1 CEU.

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

    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 pre-approved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization to which you wish you apply credit.

    Available Credit

    • 12.00 AMA - Physicians
    • 12.00 Attendance - General Attendance
    Please log in to register.

    In order to complete the on-line forms, you must be logged into your account. Once logged in, get started by clicking “Continue” and viewing the “CE Info”; then follow the prompts at the bottom of the screen. At the end of the activity, you will be able to view, save, or print your certificate of participation. A complete listing of all of your activities can be found under “My Account”, “My Activities.”