The AHCCA Edge
Rooted in compliance rules and guidance directly from ICD-10-CM guidelines, "The Coding Clinic" provided by the American Hospital Association, and CMS risk adjustment training and education materials, RISE has developed a best in class coding certification which fully prepares the coding specialist and auditor for RADV audits. The certification demonstrates mastery of advanced skills in boosting levels of coding specificity and compliant documentation practice at the provider level. The AHCCA exam was developed under the tenant that mastering ICD-10 coding comprehensively and compliantly on the front-end when coupled with faultless chart documentation on the back-end is achieves the "Holy Grail" of robust ICD-10 code capture to feed HEDIS performance, clinical gaps in care identification, and revenue accuracy. Our exam prepares you precisely for this.
It is essential to have a credential with either the AAPC (such as a CPC) or AHIMA (e.g., RHIT or CCS) as evidence of adequate training and preparation for the AHCCA. From there, the AHCCA training delves deeply into the knowledge an HCC coder needs to succeed. Those that will benefit the most from this certification include all levels from individual staff member to management to leadership in:
- HCC coding / documentation
- Data analytics
- CDI and quality management
- Auditing / compliance / revenue quality
- Provider education on HCC and coding
Building on the knowledge you’ve gained by attending one of our in-depth workshops or online courses, the AHCCA certification will take your understanding of coding to a whole new level.
You’ll walk away Understanding the ICD-9 and ICD-10 medical coding thoroughly, not only at a level required for E&M coding, but at a level required to meet the requirements of a robust and compliant HCC coding and documentation program. You will be able to demonstrate competence at applying criteria, as when and how to appropriately use common tools such as “MEAT” for discernment purposes, the proper use of Past Medical History, and more.
See the Big Picture
Understand the workflow sequencing and dependencies that begin with the face-to-face encounter between the clinician and the patient in the exam room, the documentation in the medical record, and the crucial test posed by audit validation. We delve into the uses of prospective, retrospective, and concurrent review, as well as the workflow associated with chart retrieval processes at the provider and payer levels.
Discern the linkages between risk adjustment programs and activities with those of Stars / Quality / HEDIS, as well as provider relations and provider education, with regards to charting, documentation, and audit administration. This applies equally to ACO and other MACRA-related quality programs.
Be Compliant and Mitigate Risk
Navigate the RADV programs for both Medicare Advantage and HHS Marketplace, the key differences and similarities. Understands the programmatic approach to preparing for and fulfilling a RADV audit, and the dependencies between the payer and provider, master the timeline and requirements. Be prepared for the "acid test" of real RADV audits. The on-line certification exam tests your skills in applying acquired knowledge to "cold charting" cases that simulates real-world conditions required of advanced HCC coding professionals. Case scenarios will be presented to you for your skilled handling and processing. Passing this exam certifies that you can apply the best practices level of ICD-10 coding skills and to discern the necessary level of documentation to pass a RADV audit.