The goal is revenue integrity. Your task as an HCC auditor is to know what to look for, effectively communicate your findings, and proactively position your organization for success in the risk adjustment world.
Following the guidance in the “Medicare Managed Care Manual,” HCC: Auditing in the Risk Adjustment Environment provides the essential information internal HCC auditors need to ensure their organization receives the reimbursement they are entitled to and that codes and claims are supported by clinical documentation.
- The sources of guidance for Risk Adjustment Coding
- Understanding what RAD-V and other external auditors are looking for
- The role and responsibilities of the internal auditor
- Creating policies and procedures to support accurate and complete HCC coding
- Tips and techniques for conducting effective and productive HCC audits
Other Courses by Rose T. Dunn, MBA, RHIA, CPA, FACHE
- Foundational training on HCCs and Risk Adjustment is offered in HCC: Fundamentals of Hierarchical Condition Categories
- Are you looking for hands-on practice in HCCs? HCC: Fundamentals of Hierarchical Condition Categories with Practice Cases includes “Abstract & Code It!” exercises to reinforce learning (requires textbook).