The proposed changes for Medicare Advantage in CY 2024 are going to be significant. This includes changes to HCC coding, disease mappings, disease coefficient values, and will affect all aspects of risk adjustment scores across all Medicare Advantage Organizations. The change will also affect how ICD-10-CM codes are currently mapped. The version transition will see the deleting of 2294 diagnosis codes that will no longer map to an HCC but, also added 268 diagnosis codes which will now map to an HCC in v28. Fee for service will also greatly be impacted during this change. Risk adjustment has never been under scrutiny as it is today. We will also discuss how to survive an OIG audit and maintain documentation compliance during the transition.
Risk Adjustment Overview
Review and discuss the Proposed Changes for Medicare Advantage Plans in 2024
Discuss the change from Version 24 to Version 28 and the impact on the Risk Adjustment Calculation Methodology
Learn the documentation standards
Review real-time medical records to discuss documentation and compliance
Polling audience regarding scenarios of compliant HCC assignment
Know how the change will affect Risk Adjustment Factor (RAF) Scoring
Review numerous examples of how the change from Version 24 to Version 28 will affect Condition Counts along with Disease Interaction and Coefficients
Explain how Fee-for-Service will be impacted by the changes
Areas Covered in the Session
What is Risk Adjustment?
Risk Score Calculation
Risk Adjustment Models
Two Most Frequently Used Models
HHS-HCC Code Mapping
Medicare Advantage Risk Adjustment Model (V24)
Medicare Advantage Risk Adjustment Model (V28)
Version 24 to Version 28: Why Change?
Based on ICD-9-CM Methodology
Why Do Medicare Advantage (MA) Payments Matter?
CMS Medicare Advantage (MA) Announcement
Risk Score Trends
Blended Risk Score (Non-PACE Model)
Version 24 to 28 – What is the Impact?
Projected Changes for non-ESRD (Aged + Disabled)
Deaths from COVID-19
Variations from PHE to Non-PHE
CY2024 Re-Calculation Model
Why Change? Is Medicare Advantage under Attack?
Summarizing the Changes
Specific conditions were re-mapped
Specific conditions were re-grouped
Specific conditions were reconfigured
Underlying diagnosis changes
What Can We Expect In the Future?
Reclassification and Payment
Removal of HCCs
HCC and Similarity Between MA and FFS
Updates to Part D
Updated Part D Benefit Update (LIS) and Retiree Subsidy
Amy is a manager with more than 20 years of medical billing and coding experience. Her high-level auditing skills encompass both facility and professional fee services. Specializing in revenue cycle management, inpatient/OP/OBS/ANC/ED and SDS, Amy’s broad expertise includes RAC reviews, charge master reviews, inpatient MS-DRG and APR-DRG, outpatient coding assessments and clinical documentation improvement.
Having managed large coding departments and teams, Amy is an exceptional leader and trainer. She brings to Pinnacle vast experience and talent that can transform entire coding departments and achieve improved performance, quality and accuracy. She is also exceptional at locating areas for improvement and developing processes that address specific issues in order to maximize individual and team potential.
Prior to Pinnacle, Amy held several director, management and lead educator positions where she was responsible for facility coding, auditing and review, P/L, revenue cycle, and the managing of pro-fee audit for specialty clients including physician evaluation and management leveling. She was also responsible for the oversight of hundreds of coders and multiple locations where she provided staff with ongoing training.
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