• Pharmacology
• Risk Adjustment Models:
– Hierarchical Condition Categories (HCC)
– RxHCC (Prescription HCC)
– Commercial Risk Adjustment Models (ACA)
• Introduction to AHA Coding Handbook.
• Coding Clinic with Quarter Explanation.
• PCS Guidelines.
• ICD-10-CM Coding: Accurate diagnosis coding for chronic conditions and comorbidities.
• Physician Query.
• AMA CPT Assistant.
• Medical Documentation Guidelines: Ensuring documentation supports the codes assigned.
• PDX and SDX Selection.
• Mercks Manual Discussion.
• Compliance and Regulations :HIPAA, medical ethics, and fraud prevention in risk adjustment
• Clinical Indicators
• Labs and Clinical Pathology.
• Data Quality and Validation : Auditing principles to ensure accurate risk adjustment coding.
