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January 25, 2017

The New World of HCCs: What You Need to Know Now

Presented by
The Hierarchical Condition Categories or HCCs are the new reimbursement methodology to which you must quickly adapt as an HIM professional. HCCs are different than DRGs and E&M levels. You need to know how they are different and what documentation qualifies to be used for assigning codes for claims. You need to know what must be present in the medical record documentation to permit a condition to be reported on the claim. And not knowing will impact your medical staff profiles upon which their reimbursement is based. So you need to know.

And this webcast will help you— especially if your facility is participating in a risk-based plan in collaboration with Medicare Advantage, where sharing of the profits (or losses) are based on the coding and quality of care, measured by the outcomes and costs.

Learning Objectives

From this important webcast you will...
  • Understand the components of an HCC, distinguish between related and unrelated conditions, and the role of chronic conditions.
  • Recognize that the role of the coder will change in an HCC reimbursement environment and what must be present in the medical record documentation to permit a condition to be reported on the claim.
  • Learn how the CMS HCCs and HHS HCCs differ and how the payments for HCCs are administered and when they are recalibrated.
  • Distinguish between the types of external auditors that assess the validity of the claim data and codes submitted by providers through the health plans.
  • List actions that can be taken to enhance clinical documentation that supports the care provided for the patient's conditions.

December 15, 2016

How Mount Sinai Health System is Confronting DRG Downgrading

Presented by
There's a national epidemic that is significantly impacting America's hospitals. It is the tyranny of DRG downgrading.

No doubt you and your facility are also struggling to comply with professional coding and billing standards while having to address the often arbitrary requirements of third-party vendors. You must adhere to legal and ethical standards of coding and billing while these auditors often impose arbitrary requirements of their own invention. The result of this current trend is that your facility's quality indicators and revenue can be adversely impacted by these standards.

Fortunately, during this upcoming timely and important webcast, you will benefit from learning how Mount Sinai Health System is addressing diagnosis-related group (DRG) downgrades, including their successes, challenges, and future goals.

Learning Objectives

From this time-sensitive webcast you will be able to...
  • Identify current trends in DRG downgrading
  • Discuss the interdepartmental process required for DRG appeals
  • Understand the roles of coding and clinical documentation improvement (CDI) professionals
  • Assess the key issue of relying on coding guidelines versus clinical indicators
  • Understand the impact of DRG downgrading