Sunday, May 15, 2011

Recently Posted Tools and Documents on HCC University

We want to ensure that HCC University and the HCC University blog are your favorite risk adjustment related websites.  So, over the past few weeks, we’ve posted a large number of tools and documents on  Since none of us has time to check every day, we thought we’d give you an overview of what’s gone up on the site recently.

Full Encounter Data Information -  ICD 10/Full Encounter Data Page

Updates from the CMS Work Group Conference Calls have been posted:

Capitated and Staff Model Plans Summary Notes
Encounter Data Newsletter - Quarter 2
Encounter Data Work Group Summary Notes for Editing and Reporting: Key Findings and Recommendations #2
Third Party Submitters Work Group

Risk Adjustment Tools

2011 HCC List-Diagnosis Code Grouping - this file shows diagnosis codes grouped by HCC category.  Categories or codes with problematic guidelines have documentation and coding notes. - Excel file here.

Risk Adjustment Data Validation Tools

This checklist was used in the last National RADV to assist health plans in selecting the "One Best Medical Record" for submission.  Download here.

CMS Pilot RADV Findings—for services rendered July 1, 2001 through June 30, 2002, Published July 27, 2004.  Study findings here.

Annual Wellness Visit Tools

Annual Wellness Visit Presentation --Power Point Presentation.

Annual Wellness Visit form, instructions, and USPSTF Preventive services schedule - Zip File Here.

If you have questions, comments, or suggestions for new tools, leave us a comment here, or email us at

Tuesday, May 3, 2011

Creating Your Own Internal RADV Program

Today, we have a special guest posting by Debra Braden, CPC, CUC, HCC Coding Project Specialist:


Why would you want to create a RADV program?  Having an internal RADV program in place offers several benefits.  One benefit is that the program helps you prepare for the CMS RADV process.  Another benefit is that you gain an understanding of the current risk level.  Last but not least, you are able to evaluate physician’s documentation and offer feedback.  This benefit provides continuous improvement.

To help ensure a successful RADV audit, consider the following:

  • Set up a RADV team
  • Specify who will do which part of the RADV process
  • Plan the audit process
  • Set a timeline for achieving specific goals
  • Ensure that your data systems appropriately track claims and encounter data and that reporting is readily available.
  • Eliminate providers who don’t qualify to submit HCC’s
  • Ensure that your contact information for physicians, hospitals and other facilities is up to date
  • Contact providers with request for medical records
  • Follow up on requests based on a predetermined timeline
  • Create indexing and storage processes for image files for future RADV audits
  • Keep track of record receipt progress
  • Audit received records
  • Request attestations when necessary (note that in a CMS RADV, only CMS generated attestations are accepted)
  • Review data prepared for submission to CMS for accuracy
  • Track ways to improve the process for future audits all through the audit processes
  • Provide education for providers who need to improve their documentation and coding practices
  • Conduct ongoing mock or independent RADV’s

Internal RADV audits can help to reduce financial risk by alerting medical groups and plans about physicians who need training, alerting plans about codes that should be sent to CMS for deletion, and by streamlining and refining the process for future CMS RADV audits.

With proper planning and implementation, RADV audits can be completed on time and produce the best possible results for all parties within the healthcare delivery system.

For additional useful information please visit:

HCC Tools Page

Risk Adjustment Data Validation Study - Frequently Asked Questions

RAPS Participant Guide

For additional useful information please visit:

HCC Tools Page

Risk Adjustment Data Validation Study - Frequently Asked Questions

RAPS Participant Guide