The Medicare Risk Adjustment (HCC Coding) course is designed to introduce students to the concept of insurance companies receiving funds based on Hierarchal Conditions Codes (HCC). Sicker patients or patients with chronic disease will have higher healthcare costs associated with their care. Medicare has developed a system that will reimburse health plans and providers additional amounts for caring for patients who may require more services.
| Module 1 | Introduction and Objectives |
|---|---|
| Lesson 1 | Intro and Objectives |
| Lesson 2 | Poll/Survey |
| Module 2 | Definitions and History of HCC Coding |
| Lesson 1 | Definitions |
| Lesson 2 | History of MRA and HCC |
| Module 3 | Specific HCC Codes and Factors |
| Lesson 1 | List of HCC Codes |
| Lesson 2 | HCC Codes and Their Factors |
| Module 4 | Medicare Advantage Funding from CMS |
| Lesson 1 | Funding Principles |
| Lesson 2 | Sample Medicare Advantage Companies |
| Module 5 | Case Scenario |
| Lesson 1 | Limited Documentation |
| Lesson 2 | Complete Documentation |
| Lesson 3 | Potential Revenue Loss |
| Module 6 | Sample Reports |
| Lesson 1 | MRA Reporting by Plan |
| Lesson 2 | High Cost Patient with LOW MRA |
| Lesson 3 | Help From the Health Plans |
| Module 7 | HCC Coding Tools and Resources |
| Lesson 1 | HCC Coding Tools |
| Module 8 | Summary |
| Lesson 1 | Summary |