JS1418 North Texas Specialty Physicians: Risk Adjustment Factor (RAF) University (050714)

May 7, 2014

This course provides attendees with the training required to answer provider questions about the Medicare Advantage CMS-HCC Risk Adjustment policies as defined by CMS and implemented by various third-party Medicare Advantage Organizations (MADs) in accordance to the Balanced Budget Act of 1997.

The CMS-HCC Risk adjustment methodology importance is explained because itensure more accurate payments to Medicare Advantage organizations based upon the health status of their enrolled beneficiaries . As a result, risk adjustment strengthens the Medicare Advantage program, thus placing member into the appropriate risk category for expected resource allocation.

A fundamental knowledge of the history of this particular capitated payment methodology based on patient risk, including the current political climate and government mandates as required by the Affordable Care Act will be delivered to help explain the purpose and rationale of the Risk Adjustment program. In addition, the importance of proper chart documentation and ICD-9-CM diagnosis coding to the highest level of specificity will be emphasized for accurate Risk Adjustment payments.

This information will develop an understanding of payment programs based on government reimbursements for high risk members to help keep membership premiums affordable to all participants, improve the quality and quantity of risk adjustment data submitted, and, thereby, to more accurate funding by CMS to support medical necessityand resource allocation, and to improve other government sponsored quality and rating program metrics.

Target Audience

This course is designed for physicians of all specialties.

Learning Objectives

Upon completion of this activity, participants should be able to:

1. State the purpose of Risk Adjustment Payments.

2. Recognize the Hierarchical Condition Category (HCC) Risk Adjustment model that CMS uses for payment to Medicare Advantage Plans.

3. Explain the increased importance of proper chart documentation and ICD-9-CM diagnosis coding, with appropriate specificity for accurate Risk Adjustment Payment and available Risk Adjustment tools utilized by the NTSP Provider Engagement Outreach staff and additional education available through staff.

4. Describe the risk adjustment data validation process and principles.

5. State the reporting and payment periods related to Risk Adjustment.

Course summary
Available credit: 
  • 1.75 AMA
  • 1.75 Attendance
  • 1.75 Ethics
Course opens: 
Course expires: 
Event starts: 
05/07/2014 - 5:30pm CDT
Event ends: 
05/07/2014 - 7:30pm CDT
1701 River Run
Fort Worth 76107
United States

Stuart Pickell, MD- Course Director, Speaker

Available Credit

  • 1.75 AMA
  • 1.75 Attendance
  • 1.75 Ethics


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