CMS & HHS Risk Adjustment 101 and HCC Coding Accuracy

A Two Day Workshop for Risk Adjustment Pros

June 5-6, 2017
Boston, MA

What You'll Hear

The RISE Association Risk Adjustment Academy presents a two-day, jam-packed workshop: The CMS & HHS Risk Adjustment and HCC Coding and Accuracy 101 Workshop. This enticing offer gets you a front row seat, launching you into both Medicare Advantage and HHS commercial marketplace risk adjustment. Headhunters and employers are clamoring for risk adjustment pros like you, and this event will get you up to speed fast. Whether you are a newbie or just want a refresher to fill in your blind spots, you will only find this preparation available through the RISE Association. Every year more professionals turn to us to understand how risk adjustment, quality and revenue-optimization dynamics, regulatory changes and strategies are evolving. These are developed by industry peers across the country, professionals eager to share their expertise and to help boost industry bench strength and compliance.

Day one provides you with top-notch speakers and a take-home manual that spells out the breadth and depth of the 101 workshop. Day two applies the background you cover in the 101 session and moves into a roll-up-your-sleeves intensive that applies HCC coding to the real world. Coders get a handle on critical methods to ensure optimal HCC capture while maintaining vigilant compliance with CMS guidelines. These are timely topics in great demand. Now you can access these programs with a concentrated focus to maximize your learning!

Day 1 - Risk Adjustment 101 Gives You a Comprehensive Perspective:

This workshop sets the stage and answers important questions: how did we get risk adjustment in Medicare Advantage? What is it all about and how does it work in practice? The program gives a solid foundation and overview of risk adjustment models by line of business, both Medicare and HHS. It paints how typical risk adjustment shops are set up and operate at the health plan level. It goes into prospective assessment and retrospective review stratification, target lists, strategies, options, and more. You will get to see the arithmetic penciled out and the dots connected. It also explains the need for close coordination with care management, HEDIS/Stars, and provider engagement, which is really the heart of an aligned and accountable health care system. Whether you want to just “brush up” or you need to “start-up,” this is where you need to be. This is a big note-taking day, and we supply the workbooks.

Day 2 - HCC Coding Accuracy 101:

HCC coders come to this event primed and ready to go. Finance, IT and analytical staff also have big “aha’s” when they take seats at the table to learn with the HCC coders. The workshop is structured to be highly interactive and uses case studies and small group sessions to drive home the lessons available to be learned from the pros. Coders really care about the quality of their “game.” For those accustomed to FFS coding and just a hint of HCC coding, our HCC Coding Accuracy workshop fills in the blank spots in your training and then some. It goes deeper into scenarios and cases to deepen the coders’ skill sets. The workshop features expert coder faculty members who have grappled with the same tough situations you will encounter or ones you currently struggle with already. They provide a supportive approach to group discussion and reasoning, plus a weight of experience and perspective that helps shape your confidence to take your game up another level. When do you query the clinicians? How do you approach them? What makes the difference between a good CPT coder and a good HCC coder? The workshop will help you hone your skills, increase your coding accuracy and your productivity, as well as improve your value to your organization from the perspective of quality and compliance.

Medical charts are the touchstones for RADV audits. CDI fits hand-in-glove with the data quality and risk mitigation programs in risk adjustment. How do you walk back from a claim or an encounter to a high value chart that passes CMS muster? Get crystal clear information on how chart documentation and flow of information ends up in a RAPS file or how an encounter will survive a RADV audit, no matter what line of business you are supporting. Know which portions of the chart will be acceptable and which will not when it comes to RADV audits. Get ready for 100% RADV audits for the health insurance exchanges. Get prepped for the stepped-up CMS RADV program being launched now.

Give yourself and your staff the opportunity they need to learn the whole picture and gain the business literacy of risk adjustment and HCC coding. Sign up your team for the day-long sessions taught by first-hand experts with a passion for bringing up the next generation of professionals.

Our Distinguished Speaking Faculty / Featuring Case Studies and Expert Presentations


  • Manuel (Manny) Gaidola, Director, Medicare Revenue Operations, Martins’ Point Health Care, Portland, ME
  • Kathryn Roach, Program Manager, Harvard Pilgrim Health Plan, Boston, MA


  • Donna Malone, CPC, CRC and ICD-10 Trained, Senior Manager: Enterprise Risk Adjustment, HCC Coding and Quality Assurance, Tufts Health Plan, Boston, MA
  • Colleen Gianatasio, Risk Coding and Education Specialist, Capital District Physicians’ Health Plan, Albany, NY

Top Reasons To Attend

  • Come up to speed in a single day of concentrated study on both CMS and HHS risk adjustment from end-to-end
  • Longer-term risk adjustment players: fill in where home-grown training left you with knowledge gaps
  • Visualize the linkages between the many critical roles in the larger scope of risk adjustment and understand how to optimize your own contributions
  • Gain a comprehensive perspective on how risk adjustment drives the financial health of the healthplan and its downstream provider partners
  • Upgrade your professional mastery in the discipline of risk adjustment
  • Lay the groundwork for your future career and your ability to prove your value as a key contributor and performer
  • Grasp the essential thought process to discern HCC-valid diagnoses in charts using proven techniques
  • Internalize the fundamentals of how HCC hierarchies operate and the financial and care management implications for diagnostic coding
  • Master the imperative judgments involved in applying ICD guidelines and the RADV-compliance guidance inherent in high performance HCC coding work
  • Hone your discernment and thought process through peer-level discussions, sharing and case studies

This program has the prior approval of AAPC for 13 continuing education hours (7 for CMS and HHS Risk Adjustment 101, and 6 for HCC Coding Accuracy). Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. This approval is valid until 4/30/2018.

Who Should Attend

Professionals working with risk adjustment in Medicare Advantage and the HHS health insurance exchange marketplace, including plans, issuers, and providers operating at-risk from the following backgrounds:

  • Risk adjustment management and staff
  • HCC coders (with or without AAPC or AHIMA certifications)
  • At-risk provider groups, including ACOs
  • Clinical documentation improvement (CDI) professionals
  • Compliance, legal, and quality audit personnel
  • Finance/revenue management
  • Actuarial staff
  • Medical directors and physician leaders
  • Government programs and marketplace plans
  • Provider contracting/management

Get Answers To These Important Questions

  • How does risk adjustment work and how does it all come together?
  • What are analytics and how are they used to identify documentation-gaps?
  • What is the difference between CMS and the commercial HHS marketplace risk adjustment? What is the same?
  • Can you optimize revenue while maintaining regulatory compliance?
  • What parts of the medical record can be used for diagnostic codes in retrospective chart reviews? What are RAPS files and how do they affect risk adjustment factors and revenues? How will the new EDPS process affect the financial picture for CMS premiums in 2016 and on?
  • Can you link risk adjustment with quality metrics?
  • What are best practices for RADV audit preparation?
  • What are the most common errors made in chart documentation that fail validation under an audit?

In order to secure a group discount, all delegates must place their registrations at the same time. Bring your providers: they count towards group rates! Groups must be registered and paid for by the same organization Group discounts cannot be issued retroactively. For more information, please contact Whitney Betts 704-341-2445 or e-mail at

When & Where

June 5 & 6, 2017

The Harvard Club
374 Commonwealth Avenue
Boston, MA 02215

Room rate is $249/night - mention the “Risk Adjustment & HCC Coding 101 Workshop” when placing your room reservation


Register Now: Space is Limited!

For more information and to register, contact Whitney Betts at 704-341-2445 or Group discounts available!

[+] Register Now


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