Medicare Advantage Risk Adjustment for Professional Services
March 22, 2019
1:00 – 2:00 PM ET
CEU: 1.0 – Clinical Data Management
The risk adjustment payment methodology for reimbursement of Medicare Advantage (MA) professional services began in 2004. Risk adjustment applies to all face-to-face services provided to MA patients by eligible providers, and valid documentation of all diagnosis codes that risk adjust must be present in the medical record. This presentation will review the basics of risk adjustment, best practice for documentation relating to risk adjustment methodology, industry standardized tools for documentation, and CMS risk adjustment data validation (RADV) audits.
Presented by Alison Gibson, CPC, CRC, CEMC
Alison Gibson, CPC, CRC, CEMC
Alison Gibson, CPC, CRC, CEMC has worked in the HIM field for the last 12 years. Starting in accounts receivable, she quickly progressed to coding, auditing, and education. From there, she worked to create EHR templates for a large physician group, focusing on ’95 and ’97 E/M guidelines and thorough quality measure documentation. She went on to serve as a Value-Based Project Supervisor, implementing network-wide performance improvement initiatives, creating quality measure dashboard views in the EHR, and supervising a team responsible for care gap closure and quality reporting for all insurers. She now works for Optum360 as a Clinical Language Intelligence Development Product Specialist. In addition to her coding certifications, Alison is also Certified MACRA & MIPS Proficient (CMMP). She is currently enrolled in her last semester of the Bachelor of Science, Health Information Management program at Western Governors University. Alison lives in Pennsylvania with her husband David and her daughters Arianna, 9, and Veronica, 2.
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$20 – LHMHIMA Members
$35 – Non-members
$0 – Students
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