Distheone
New
I am studying for the CRC and need some assistance. Exactly what does compliance mean in regards to HCC coding?
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Wiki Compliance and HCC Coding
- Thread starter Distheone
- Start date
sconnell08
Networker
Good morning:
I would be more than happy to clarify that for you. If you look at the exam breakdown, there will be 23 questions regarding compliance as it relates to risk adjustment. In that section, there will be questions surrounding coding errors on RADV audits, process of RADV audits, and processes of prospective and retrospective audits.
In terms of compliance around prospective audits, one must pay attention to how CDI efforts are being conducted and their approach. One example of a compliance concern from a prospective audit, is how a coder presents CDI opportunities to the provider in order for it not to appear leading or telling the provider what to code. CMS has some great resources for RADV audits and I would highly recommend that you take some time to review said documents. If you have any questions, please do not hesitate to reach out. Have a great day!
I would be more than happy to clarify that for you. If you look at the exam breakdown, there will be 23 questions regarding compliance as it relates to risk adjustment. In that section, there will be questions surrounding coding errors on RADV audits, process of RADV audits, and processes of prospective and retrospective audits.
In terms of compliance around prospective audits, one must pay attention to how CDI efforts are being conducted and their approach. One example of a compliance concern from a prospective audit, is how a coder presents CDI opportunities to the provider in order for it not to appear leading or telling the provider what to code. CMS has some great resources for RADV audits and I would highly recommend that you take some time to review said documents. If you have any questions, please do not hesitate to reach out. Have a great day!