Decoding Essential Elements Of Risk Adjustments, HCC, RAF Scores & RADV Audits

Step into the dynamic world of a Certified Risk Coder (CRC) with this engaging presentation designed to demystify the essential elements of risk adjustment. Whether you're new to the field or looking to solidify your expertise, this session will walk you through the foundational concepts of Hierarchical Condition Categories (HCCs), the building blocks of RAF scores, and the pivotal role of risk adjustment in value-based care. Explore practical applications of coding scenarios that demonstrate how accuracy and compliance intersect with improved healthcare outcomes and organizational success.

From understanding MEAT criteria to navigating key ICD-10-CM guidelines and RADV audits, this presentation offers actionable insights that prepare coders to excel in today’s risk adjustment landscape.

Webinar Objectives

• Define the purpose and value of risk adjustment in healthcare
• Explain how HCCs, RAF scores, and STAR ratings interconnect
• Describe the main risk adjustment models and their applications
• Apply ICD-10-CM guidelines to ensure coding accuracy and compliance
• Navigate common coding challenges, including trumping and RADV audits
• Understanding the why behind what CRCs do and then see what that looks like in application 

Webinar Agenda

• Introduction to Risk Adjustment
• Overview of Hierarchical Condition Categories (HCCs)
• Overview of the RAF Score (Risk Score)
• The Three Main Risk Adjustment Models
  • Medicare Advantage (CMS-HCC)
  • Commercial (HHS-HCC)
  • Medicaid (CDPS)
• Retrospective, Concurrent, and Prospective Reviews
• STAR Ratings and Financial Implications
• Coding Essentials for CRCs
• MEAT Criteria, Trumping Rules, and the role of the Coding Clinic
• Risk Adjustment Data Validation and Compliance
• Interactive Coding Scenarios for Practical Application of Key ICD-10-CM Guidelines and risk adjustment coding concepts
• Q&A Session

Webinar Highlights

• Live walkthrough of mock coding scenarios
• Practical application of trumping logic and Coding Clinic guidance 
• Understand the why of risk adjustment and how it creates equity for the patients 

Who Should Attend

This presentation is perfect for:

• Certified coders and coding professionals aspiring to deepen their risk adjustment knowledge
• Healthcare professionals transitioning into risk adjustment roles
• CRC candidates or recent graduates seeking practical application guidance