Risk Adjustment Tactics to Boost Code Levels & Increase Pay


You can get paid MORE for your Medicare Advantage (MA) claims by accurately reporting patient risk– if you know how…

Although this additional MA reimbursement is just waiting to be claimed, accessing it requires you to jump through a few hoops. To get paid more for your MA claims, you must know how to identify the key elements in your provider’s documentation, and accurately report additional risk-adjustment qualified diagnoses codes on your claim (only about 11% of the over 75,000 available ICD-10-CM codes are eligible).

There is someone that can help….

During this online training, coding expert Leslie Boles, BA, CCS, CPC, CPMA, CHC, CPC-I, CRC, will walk you through how to more accurately apply HCC-qualified diagnoses to your patients’ ailments. And with massive updates to the E/M codes hitting on Jan. 1, you don’t have much time to get it right. By mastering how to correctly report patient risk on your Medicare Advantage and ACA claims, to can receive more of the reimbursement you are due.

IMPORTANT: Effective Oct. 1, there are 3 new diagnoses approved for use when coding patient risk (Z59.82: Transportation insecurity, Z59.86: Financial insecurity, and Z59.87: Material hardship). During her training, Leslie will walk you through how to correctly utilize these new codes to improve your outcomes.

Here are just a few of the risk adjustment coding tactics you’ll master during this 60-minute online training:

  • Isolate documented patient social history phrases that can boost your pay up
  • Make risk-adjustment coding easier by accurately utilizing hierarchical groups
  • Pinpoint how new 2023 E/M rules will impact your risk adjustment coding
  • Improve risk coding results by utilizing new diagnosis codes (effective Oct. 1)
  • Correctly use risk adjustment to code to the highest level of specificity
  • Effectively apply HCC diagnoses to your patients’ ailments so you don’t undercut pay
  • Reduce Medicare Advantage driven audits with risk adjustment evaluation tool
  • Accurately close documentation gaps and identify missed HCC opportunities
  • Get your docs to REALLY include what you need to justify higher HCC reimbursement
  • Avoid the top conditions that cause coding errors, and will get you audited
  • Incorporate risk-adjustment coding tactics to your ACA plan claims and boost pay-up
  • And so much more…

IMPORTANT: Auditors are watching how you interpret HCC data from your patient charts. Remember, risk-adjustment coding (and reimbursement) is based on how sick your patients are, and their situation (job, marital status, where they live, etc.), not the number of visits or procedures performed. Accordingly, this online training is your best way to increase your MA and ACA claim reimbursement while staying on the right side of an audit.

Stop losing money on your Medicare Advantage claims. Register for this can’t-miss online training today to help you avoid missing even one risk adjustment coding opportunity (and the added reimbursement it generates). Hurry! Don’t wait. Sign up today.

Who should attend this training?

  • Practice Managers
  • Physicians
  • Non-physician Healthcare Professionals
  • Coding Managers and Professionals (inpatient and outpatient)
  • HIM Managers and Professionals
  • Medicare Advantage Payers
  • Quality Professionals
  • CDI Managers, Directors, and Specialists

Meet Your Expert

Leslie Boles
BA, CCS, CPC, CPMA, CHC, CPC-I, CRC Compliance Audit Director and Coding Instructor

Leslie is currently Director of Compliance Audit at Waud Capital Partners and as a Coding Instructor at Rutgers University. She has more than 13 years of experience in outpatient coding, auditing and compliance, and coding education.

Leslie prides herself in being able to present very complex coding and documentation regulations in a simplified manner. She has the credentials of CCS, CPC, CPMA, CHC , CPC-I and CRC from the American Academy of Professional Coders® (AAPC®), American Health Information Management Association (AHIMA) and the Health Care Compliance Association (HCCA).

Leslie has developed and implemented multiple training programs on physician coding and documentation, Medicare and Medicaid policy and compliance programs. She holds a bachelor’s degree in Healthcare Administration from The University of Arizona and is currently a member of the Board of Directors and is Co-Chair of the Compliance Committee of the Healthcare Financial Management Association (HFMA), NJ chapter.