Introduction to Medicare Advantage Risk Adjustment: On-Demand

Activity description 

The Centers for Medicare & Medicaid Service (CMS) risk-adjustment model uses the Hierarchical Condition Category (HCC) method to calculate risk scores based on accurate diagnosis codes reported by providers to Medicare Advantage Plans. This is dependent on complete and accurate coding and documentation to the highest level of specificity to relay the complexity of a patient’s health status.

This presentation includes an introduction to Medicare Advantage (MA) risk adjustment, including the Centers for Medicare and Medicaid Service’s Hierarchical Condition Category (CMS-HCC) model.

Provided by
This activity is jointly provided by OptumHealth Education and Optum Risk, Quality & Network Solutions.

Commercial support
There was no commercial support received for this activity.

Hardware/Software requirements
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Target Audience

This activity is designed to meet the educational needs of coders and physicians that have an interest in learning about the importance of accurate coding and documentation.

Learning Objectives

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

  • Explain the process of risk adjustment used by the CMS to reimburse MA plans.
  • Describe how the CMS-HCC risk-adjustment model is utilized to calculate risk scores.
Activity summary
Available credit: 
  • 0.50 AAPC
  • 0.50 AMA
  • 0.50 Attendance
Activity opens: 
Activity expires: 


Sarah Chart, RN
Senior Director
OptumHealth Education

Rebecca Gleason, RN, CCM
Activity Manager
OptumHealth Education

Crystal Wong, MD
Propoint Medical Writing


Faculty Photo

David S. Brigner, MLAS, CPC, CPC-I 
Senior Provider Training & Development Consultant
Optum Risk, Quality & Network Solutions 

Faculty PhotoAmber Green, DNP
National Vice President of Training, Provider Engagement & Strategy
Optum Risk, Quality & Network Solutions
Faculty PhotoCarrie Mann, MBA, CPC, CPC-I
National Director of Training, Provider Engagement & Strategy
Optum Risk, Quality & Network Solutions
Faculty Photo

Senior Provider Training & Development Consultant
Optum Risk, Quality and Network Solutions

Faculty Photo

Michelle Tulier, CPC, CDEO, CPMA, CRC, CPC-I
Senior Provider Training and Development Consultant
Optum Risk, Quality & Network Solutions

Disclosures of relevant financial relationships
In accordance with the ACCME Standards for Commercial SupportSM, OptumHealth Education (OHE) 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 his/her spouse/partner) has a financial relationship in any amount occurring in the last 12 months with a commercial interest. 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 Accreditation LogoIn support of improving patient care, this activity has been planned and implemented by OptumHealth Education and Optum Risk, Quality & Network Solutions. 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 healthcare team.

Credit designation statements

OptumHealth Education designates this live activity for a maximum of .5 AMA PRA Category 1 Credit™. 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.

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

AAPC-certified coders
This program meets AAPC guidelines for 0.5 CEUs. Can be used for Core A, CIC and CRC with successful completion of post-test for continuing education units.

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 with which they wish to obtain credit.

Available Credit

  • 0.50 AAPC
  • 0.50 AMA
  • 0.50 Attendance
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