Medicare Advantage Risk Adjustment – Diagnosis Documentation and Coding Importance_Enduring

This course will provide a brief overview of the importance of ICD-10-CM diagnosis reporting as it is related to Medicare Advantage risk adjustment. 

Target Audience

This course is designed for physicians, nurses, and clinical staff. 

Learning Objectives

Upon completion of this activity, participants should be able to:

  1. Enhance their performance in compliant reporting of ICD-10-CM diagnosis codes as it relates to risk adjustment methodology ensuring CMS provides proper resources for the care of patients enrolled in Medicare Advantage plans. 
  2. Improve their knowledge of the provider’s role in Medicare Advantage risk adjustment by reporting an accurate clinical picture of their patients through diagnosis code reporting. 
  3. Increase their competence and awareness of a health plan’s risk exposure with CMS Risk Adjustment Data Validation (RADV) Audits when provider-reported diagnoses are not supported in the patient’s medical record.
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.00 ANCC
    UPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
  • 1.00 Attendance
Course opens: 
11/15/2024
Course expires: 
11/15/2027
Part of: 
UPMC Health Plan – Risk Adjustment/HCC Provider Coding Education [CME]

Marlana Tice, BA, CCS-P, CPC, CCS  - AHIMA Approved ICD-10-CM Trainer - Program Director – Risk Adjustment/HCC Coding Education 

Kalpana Char, M.D., Medical Director - Assistant Vice President, Special Needs Plan Medical Services 

Molly Dell, MBA, BSN, RN - Senior Director, Risk Adjustment Government Revenue & Education 

No members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships with any companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. 

DISCLAIMER STATEMENT 

The information presented at this CME program represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine.  Reasonable efforts have been taken intending for educational subject matter to be presented in a balanced, unbiased fashion and in compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses. 

Accreditation Statement:  

In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.  

Physician (CME)
The University of Pittsburgh designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing (CNE)  
The maximum number of hours awarded for this Continuing Nursing Education activity is 1.0 contact hour. 

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity. 

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.00 ANCC
    UPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
  • 1.00 Attendance
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