Risk Adjustment

ajudd

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Do any of you coders out there work in Risk Adjustment? If you do, I would like to pick your brain a little. I'm interested in finding additional Risk Adjustment training, material, etc.

Thanks!
 

ajudd

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Hi there. SOrry for the delay, I have not checked the forum in a week!

I am wondering what resources you use for Risk Adjustment? I wish that there were classes/seminars specifically on Risk Adjustment. I have not seen anything offered ... I am looking for a seminar on Cardiology - not just coding, but what relates to what, etc. I'd like to find something I can expand on to learn more.
The local coding meetings are nice, but they seem to focus a lot on CPT and since my team focuses on diagnosis coding it would be nice to have info geared towards our job.

It just seems like most info I find is related to chart coding and there is so much more to our credential than that.

Thanks
 

johnithomas

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I know what your saying! I was able to learn HCC\Risk Adjustment when I was hired by MedAssurant....this is all they do. I dont think there is any educational books for this. We just finished with Medicare and will be doing more training for Medicaid so the rules per Insurance must be somewhat different. We went through 1 week of training and then 4 weeks of having our work reviewed by other coders who had been doing HCC coding for sometime. They sent us about 6 books on all the codes\dx's that they included in HCC, and the rules in which we could use them.
 

ajudd

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the HCC is a new department within the company that I work for so that makes finding resources a challenge I think.

What I would like, is to find some clinical training for cardiology, and neurology. I'd like to expand on what I already know, but work mock charts for related symptoms... I would like to know, if a patient has "x" that means____. Sometimes I think the information is there, just worded in a way I may not be picking up on. I am not comfortable making leaps.

I know some of it is physician teaching too. Like if a patient has a foot ulcer AND they have diabetes. Unless the chart specifically says "diabetic ulcer" I do not make that link. I would code the ulcer (hcc149) and the diabetes (hcc 19) - not the manifestion class.

Well, I am glad that there are other people out there that this makes sense to. Do you do a lot of travel with MedAssurant? Do you contact the offices to set up reviews or does someone do that for you? We make our own contact.
 

johnithomas

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I understand what your saying. HCC 15-19 can be hard to understand. It is complicated by what Medicare will allow you to do as far as making the "link". For example if its not stated as "chronic" but we can see\show from the records that there is evidence of a disease for three months then we can code it as a chronic condition. As far as what you had stated with Diabetes and foot ulcers, I would make the link to HCC 16 if there was clear evidence of Diabetes and the foot ulcer was NOT Decubitus. Chances are with the software that they use it will "kick" out again for another review b\c of the Diabetes code and now the Ulcer code. HCC 16 is higher than HCC 19, and as you know the want the highest code. I work out of my home for MedAssurant. They set up all the reviews, all I do is log-on and download what they need me to review. Hope this helps!
 

msbrowning

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Johnithomas,

How long have you been working for MedAssurant? Do they keep you busy? I read somewhere that they could not guarantee 40 hours per week on a regualr basis and there may be some times when there is no work. Is that true?
 

johnithomas

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Yes that is true. You will find that is the case with most "remote" coding jobs. You are signed on per "project". When the project is done you are done, same case here they try to keep you at 40 hrs but when the work is done its done untill they find something else.
 

Icode4U

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Icode4U

I have questions in regards to MedAssurant. Johnithomas, can you tell me how long you have worked for them? I will start my training soon. After seeing comments about the inconsistant work load, I called the "lead" that conducted my phone interview. He assured me that there is plenty of work all year long. He did say that during the month of April it is slower. He said that they were only hiring full time. I questioned him, due to the initial email from HR stating that a position with MedAssurant was perfect for someone that hold another job of 32 hours per week. I can 't imagine working at a computer for 72 - 80 hours per week. He stated that he did not know why the 32 hour comment was being made. He said that his director firmly stated 40 hours- full time coders. I am looking for input from persons with experience with MedAssurant to fill in the blanks and questions.
 
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