Introduction to Medicare Advantage Risk Adjustment: On-Demand
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.
This activity is jointly provided by OptumHealth Education and Optum Risk, Quality & Network Solutions.
There was no commercial support received for this activity.
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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.
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.
Sarah Chart, RN
Rebecca Gleason, RN, CCM
Crystal Wong, MD
Propoint Medical Writing
David S. Brigner, MLAS, CPC, CPC-I
|Amber Green, DNP|
National Vice President of Training, Provider Engagement & Strategy
Optum Risk, Quality & Network Solutions
|Carrie Mann, MBA, CPC, CPC-I|
National Director of Training, Provider Engagement & Strategy
Optum Risk, Quality & Network Solutions
Kate Tierney, CPC, CPC-P, CPMA, CRC, CPC-I, CEDC, CEMC, CGSC, COBGC
Michelle Tulier, CPC, CDEO, CPMA, CRC, CPC-I
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.
In 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.
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.
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.
- 0.50 AAPC - Coders
- 0.50 AMA - Physicians
- 0.50 Attendance - General Attendance
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