What can you do to mitigate the impact of the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Codes (CMS-HCC) risk adjustment model Version 28? This course reveals a proactive approach to mitigating the potential negative impact of Version 28 through proper identification of diseases and conditions coupled with addressing, assessing, and properly treating those diseases. It follows clinical and coding guidelines to address diagnoses and conditions for which the risk adjustment factor has been eliminated or reduced. It does this through a disciplined approach of reviewing co-morbid conditions, alternative diagnoses, and improved specificity. In all cases, the primary purpose is to treat the patient's diagnoses and conditions to improve the quality of life for the patient.
At the conclusion of this activity, members of the interprofessional team should be able to better:
- Explain that V28 is already active, hence the urgency of addressing it; what happened in 2023 impacts 2024 risk scores.
- Describe how the shift from Version 24 (V24) to V28 effects revenue; help identify risk adjustment (RA) codes with a decrease in value, requiring attention.
- Correlate the unique impact of V28 on their organization.
- Determine the financial impact of V28 on their entity.
- Build a proactive approach to identify alternative, risk adjusted codes that meet clinical and coding guidelines to improve patient care.
- Identify undiagnosed and under diagnosed codes to improve quality of care.
- Demonstrate the need for training and education.
- State the need for a comprehensive review of new and alternative codes.
- Explain how to perform an impact assessment with or without a third party.
- Describe how to use the assessment to estimate the time and resources necessary to close the gaps and mitigate V28.
Faculty includes:
Dennis P.H. Mihale, MD, MBA, CHCQM-PSRM
Julio C. Perez, MD, AHCCA
About the Authors
Members of the Education Committee, Planners, and Faculty have no relevant financial relationships with ineligible companies to disclose.
ACCREDITATION & CREDIT
The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
ABQAURP designates this enduring material for a maximum of
1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ABQAURP is an approved provider of continuing education for nurses. This activity is designated for 1.5 contact hours through the Florida Board of Nursing, Provider # 50-94.
This program is approved for Category 2 credit by the American Osteopathic Association.
This activity is valid from March 15, 2024 through March 14, 2027.
Pricing:
Diplomate Members $45.00
Professional Members $55.00
Non Members $65.00