Risky Business: HCC Coding

Needs Statement

In healthcare, providers face a challenge when it comes to enhancing risk scores for improved patient care within Value-Based Care. This challenge has a direct impact on the quality of care patients receive. It's evident that providers need to gain knowledge about effective risk score enhancement but encounter difficulties in applying these strategies in their daily practice. To address these challenges, this presentation aims to guide providers in utilizing the risk adjustment model, understanding documentation requirements, recognizing the components of risk scores, and reviewing high-yield codes. The goal is to empower providers to deliver more patient-centered care within the Value-Based Care framework while overcoming these obstacles.

Educational Objectives

At the conclusion of the session, the participants should be able to:

• Utilize the risk adjustment model to assess and predict healthcare costs.
• List the components that constitute risk scores in healthcare assessment.
• Review high-yield ICD10 diagnoses for risk scores.
• Identify the documentation requirements for a progress note to apply ICD-10 codes for Hierarchical Condition Category (HCC) purposes.

Target Audience

Activity Evaluation

Evaluation by questionnaire will address program content, presentation, and possible bias.

Educational Methods

• Lectures
• Other

Accreditation/Credit Designation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Baylor College of Medicine and Texas Health Network CIN. Baylor College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Baylor College of Medicine designates this enduring material activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Term of Approval

March 1, 2024 through March 31, 2026. Original release date: March 1, 2024.

Disclosure Policy

Baylor College of Medicine (BCM) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians. BCM is committed to sponsoring CE activities that are scientifically based, accurate, current, and objectively presented.

In accordance with the ACCME Standards for Commercial Support, BCM has implemented a mechanism requiring everyone in a position to control the content of an educational activity (i.e., directors, planning committee members, faculty) to disclose any relevant financial relationships with commercial interests (drug/device companies) and manage/resolve any conflicts of interest prior to the activity. Individuals must disclose to participants the existence or non-existence of financial relationships at the time of the activity or within 24 months prior.

In addition, BCM has requested activity faculty/presenters to disclose to participants any unlabeled use or investigational use of pharmaceutical/device products; to use scientific or generic names (not trade names) in referring to products; and, if necessary to use a trade name, to use the names of similar products or those within a class. Faculty/presenters have also been requested to adhere to the ACCME's validation of clinical content statements.

BCM does not view the existence of financial relationships with commercial interests as implying bias or decreasing the value of a presentation. It is up to participants to determine whether the relationships influence the activity faculty with regard to exposition or conclusions. If at any time during this activity you feel that there has been commercial/promotional bias, notify the Activity Director or Activity Coordinator. Please answer the questions about balance and objectivity in the activity evaluation candidly.

All of the relevant financial relationships listed for these individuals have been mitigated.