A few minutes to improve Risk documentation Accuracy even when you know nothing about Medicare Risk Adjustment

By Yves-Edouard Baron

You are a medical Doctor, a Physician Assistant, a Nurse Practitioner, or a medical Auditor or Coder......and you have just been hired by a medical practice where most patients have the Medicare Advantage plan.

One problem: you need to familiarize yourself with the Risk Adjustment field.

No worries. We GOT your back.

You can now enjoy your eBook and learn. This eBook is the easiest way to understand Medicare Risk Adjustment, the ways to improve Risk Adjustment documentation Accuracy, and the key to supporting Risk-Adjusted diagnoses and more...

No more " I am just a coder with no understanding of clinical documentation" or " I am just a clinician with no knowledge of coding guidelines." This ebook is such an easy read. There is no need to be overwhelmed. This is an excellent book to read, especially with how the risk adjustment market has been going.

By the time you're done with this eBook, you will understand more clearly why certain Medicare Advantage medical practices are thriving, and others are struggling.

 

Recognize the Power of Accurate Documentation. Whether you are a physician, nurse, coder, or any other healthcare professional, it is a shared responsibility.. 

• Language: English
• Publisher: Yves-Edouard Baron
• Release date: Jun 30, 2023
• ISBN: 9798218227937

Yves-Edouard Baron

Yves-Edouard Baron is an HCC Compliant Auditor who has been working in the Medicare Risk Adjustment field for the last 12 years. His clinical background acquired from the medical school of his native country did allow him to be a great educator for physicians, nurse practitioners, physician assistants, and medical coders on risk adjustment clinical documentation. Yves-Edouard obtained several credentials (CPC, CRC, CPMA, CDEO, CDEI, CRC-i) and has authored several published articles on risk adjustment: -Guideline I.A.15: The one that makes Risk Adjustment Coders Happy (Healthcare Business Monthly magazine) -Assess Documentation to Validate Risk Adjustment Coding (Healthcare Business Monthly magazine) -One of The Best Strategies for Risk Adjustment Medical Coders: is “Query the Physician” (BC Advantage magazine) -Realize the Importance of Risk Adjustment Coders (Healthcare Business Monthly magazine)

Book preview

Contents

Title Page

References

Disclaimer

Copyright © 2023

Epigraph

Dedication

Preface

About the Author

Acknowledge

INTRODUCTION

Chapter 1

Chapter 2

Chapter 3:

Chapter 4

Chapter 5

Test Yourself                  

Afterword

Glossary

A few minutes to improve Risk documentation Accuracy even you know nothing about MEDICARE RISK ADJUSTMENT

Improve RAF accuracy through Valid Documentation

Yves-Edouard Baron

References

American Hospital Association (AHA) Coding Clinic 

​ICD-10-CM Official Guidelines for Coding and Reporting 

​Understanding Pathophysiology, Seventh edition by Sue E. Huether; ‎Kathryn L. McCance

​BRS Pathology by Schneider & Szanto

Disclaimer

No part of this Book may be reproduced or transmitted in any form or by any means electronic, recording, or otherwise without the prior written permission of the author.

This Book does not replace the ICD-10-CM Convention, ICD-10-CM Guidelines, AHA’s Coding Clinic, or other appropriate Risk Adjustment documentation authority. The information in this book should be used only as a guide.

You are encouraged to refer to the current ICD-10-CM Official Guidelines for Reporting provisions in relevant coding and reporting guidelines.

The author has consulted sources believed to be knowledgeable in the Risk Adjustment documentation field. But the author does not warrant that the information is in every respect accurate and, or complete. The author shall not be responsible for, and expressly disclaims liability for, damages of any kind arising out of the use of the content of this Book. The author assumes no responsibility for using the information contained in the course, which is for informational purposes only.

Copyright © 2023

La Ste-Famille MRA Auditing, LLC

All rights reserved.

No part of this book may be reproduced, or stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without express written permission of the publisher.

ISBN: 979-8-218-22793-7

Cover design by: Yves-Edouard Baron

Printed in the United States of America

Epigraph

A journey of a few minutes can unlock

a world of knowledge, transforming even the unfamiliar into

a tool for accuracy and improvement.

The Author  

Dedication

To the tireless medical Doctors, Nurse Practitioners, Physician Assistants, MRA Auditors, and MRA Coders, whose dedication and expertise illuminate the path of risk documentation accuracy. Your commitment to excellence in healthcare ensures accurate risk adjustment, even in the face of challenges and uncertainties. This book is dedicated to your unwavering pursuit of knowledge, empowering you with the tools to improve and succeed. Thank you for your invaluable contributions to the field, and for enhancing the quality of care for all.

Preface

This book is dedicated to the remarkable healthcare providers, MRA auditors, and MRA coders who navigate the intricate world of risk documentation accuracy, even when faced with limited knowledge of Medicare risk adjustment. It is with great admiration and respect that I present these pages to individuals who strive to enhance the quality of care for patients while ensuring the accuracy of risk adjustment processes.

In today's complex healthcare landscape, the accurate capture and documentation of risk data are crucial for healthcare organizations, insurers, and regulatory bodies. With its detailed guidelines and evolving requirements, Medicare risk adjustment presents a formidable challenge for seasoned professionals and those just beginning to acquaint themselves with this specialized field.

This book aims to offer a guiding light to healthcare providers, MRA auditors, and MRA coders, regardless of their prior knowledge or experience in Medicare risk adjustment. In just a few minutes of dedicated learning, readers will find practical strategies, insights, and tips to improve risk documentation accuracy.

While acknowledging our readers' diverse backgrounds and expertise, this book aims to bridge the knowledge gap by providing accessible explanations and actionable steps. From understanding the fundamentals of risk adjustment to optimizing documentation practices, each chapter aims to equip you with the necessary tools to excel in this critical domain.

The knowledge shared within these pages will empower healthcare providers, MRA auditors, and MRA coders to navigate the intricacies of risk documentation with confidence and precision. By improving accuracy in risk adjustment, we can ensure fair reimbursement, enhance patient care, and contribute to the overall success of healthcare systems.

May this book serve as a valuable resource on your journey towards improving risk documentation accuracy, and may it bring about positive change in the field of Medicare risk adjustment. Together, we can advance healthcare quality, promote equitable reimbursement, and ultimately enhance the well-being of patients.

With deep appreciation,

Yves-Edouard Baron

About the Author

Yves-Edouard Baron is an HCC Compliant Auditor who has been working in the Medicare Risk Adjustment field for the last 12 years. His clinical background acquired from the medical school of his native country did allow him to be a great educator for physicians, nurse practitioners, physician assistants, and medical coders on risk adjustment clinical documentation.

Yves-Edouard is an international medical graduate (IMG) who has obtained several credentials (CPC, CRC, CPMA, CDEO, CDEI, CRC-i) and has authored several published articles on Risk Adjustment:

Guideline I.A.15: The one that makes Risk Adjustment Coders Happy

Assess Documentation to Validate Risk Adjustment Coding

One of The Best Strategies for Risk Adjustment Medical Coders: is Query the Physician

Realize the Importance of Risk Adjustment Coders

He is an active member of LSF, which provides private physician practices with services such as MRA chart reviews with clinical documentation training and Risk adjustment training for medical coders.

He always emphasizes the Power of Accurate Documentation in Healthcare. And throughout his career, he never ceases to remind us that accurate documentation is a shared responsibility, whether you are a physician, nurse, coder, or any other healthcare professional.

Acknowledge

I

am writing to express my deepest gratitude to my colleagues from Amicus MSO, where I spent ten years as an active MRA team member, for their support, encouragement, and inspiration throughout the process of writing this book. Their unwavering encouragement has been instrumental in its creation, and I am immensely grateful for their contribution.

Their adherence to accuracy in Risk Adjustment documentation has inspired me constantly. From our thought-provoking discussions during team meetings to insightful conversations over the chat, their passion for accuracy and dedication to staying informed about the latest clinical literature on risk adjustment developments in the field have truly motivated and inspired me.

I want to acknowledge the valuable insights they shared during our conversations.  Their questions regarding accuracy have challenged me to dig deeper, explore different perspectives, and ensure that the book provides a good resource for professionals in our field.

I am very thankful to Rayshelle Aparicio for her belief, from the beginning, in my abilities to perform the MRA onboarding training for healthcare providers and medical coders. I am very thankful to Anna Mattson, who sees me as the mentor who inspires her career in the Risk Adjustment business. Her unwavering support and encouragement have given me the confidence to tackle this endeavor and see it through. I am truly fortunate to have such inspiring colleagues who understand the significance of sharing knowledge and advancing our field.

Once again, thanks for their invaluable support in the creation of " A few minutes to improve Risk documentation Accuracy even when you know nothing about Medicare Risk Adjustment." Their belief in me and the importance of this topic have profoundly impacted both the book and my personal growth as an author. I am deeply grateful to have them as colleagues.

Finally, I am foremost grateful to my family, especially my wife, Myriame Baron, for supporting and encouraging me throughout