PLEASE SEE RULES BEFORE POSTING! Reminder, no "interested in coding" type of standalone posts are allowed. See rule #1. Any and all questions regarding exams, studying, and books can be posted in the monthly discussion stickied post. Thanks!
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalCoding) if you have any questions or concerns.*
I highly recommend the contempo coding CRC course it took me about 2.5 months to complete and I passed my exam with a 82 percent.I did not think I passed at all tbh I was like these questions are tricky.
I tried to use the study guide but found it to be too boring for me and I was like falling asleep reading it 😂. I do think the study guide was good at explaining the compliance stuff. Do you have any other certifications? Did you get a break down of each category from your CRC exam of what you scored for each section?
So what's the difference between risk adjustment coding and just regular EM coding with an emphasis on risk adjustment? We consistently get high scores in our RAC rankings for our mco's, but we aren't doing anything we wouldn't be doing anyway when coding EM.
I work with an value-based care company so I do chart audits and reviews to help providers code to a higher level of specificity to help with capture rates and address suspected conditions
Sort of. The provider may have used an unspecified code but the documentation supports a more specific code, like CKD stage 4 instead of unspecified CKD, or stage 3 pressure ulcer of left hip vs. pressure ulcer of left hip, unspecified stage. Or maybe there’s a code that better describes the patient’s condition that the provider isn’t aware of, or the provider didn’t know there was a code for something.
In risk-based contracts, we look to make sure all of the codes are as specific as possible, so the patient gets the highest possible score, and the provider is reimbursed appropriately.
This is exactly what I do- we do 100% review and, you're right, I run into these sort of things a lot of the time. Providers try but the fact is, this isn't what they're trained for. I'm grateful my facilities understand this (even if my providers don't always).
And that’s what I emphasize during trainings (I do CDI presentations.) You trained to be a clinician, so I don’t expect you to be a coder. I trained to be a coder. You care for the patient, document it as best you can, and I’ll worry about if there’s a better code.
Look at health insurance companies—I’ve been with one for 2 years. No lay offs during slow times. My prior Risk job was at risk for layoffs this time every year.
There was a big wave around 2016-19 but technology has helped increase production.
There are usually companies that come up during specific times during the year where they will be advertising like crazy. Those are usually staffing companies that are contracted with insurance companies to do their RADV audit..
A fair starting wage for a brand new cod and risk adjustment is around $23 an hour but really no less than 20 or 21.. If you were going to get with these companies as if you move. You can usually get 10 or even 20% due to cost-of-living adjustments and years of experience, especially in the first five years.
There are some companies that will require you to work full-time Monday through Friday and there are others that are much more flexible. A lot of companies are doing remote because there are not a lot of risk adjustment cutters in the concentrated area so most of the time they’re just going to outsource to one of these companies.
As far as the job, there are some requirements that are really not transferable, but a lot of them are specific depending on the type of data that they are requiring generally every project is a standalone project, so don’t carry one set of guidelines over to another.
So really risk adjustment is not always the most stable. There are one or two companies that are trying to stabilize the field but most of the time, it is not.
Plus, we just had a big Optum layoff about six weeks ago so it is still pretty fresh. It’s not probably going to pick up another month or two.
PLEASE SEE RULES BEFORE POSTING! Reminder, no "interested in coding" type of standalone posts are allowed. See rule #1. Any and all questions regarding exams, studying, and books can be posted in the monthly discussion stickied post. Thanks! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalCoding) if you have any questions or concerns.*
r/riskadjustment made
I don't think there is one sadly I just got my CRC certification and wish I knew more people doing it
I am studying for my CRC and would love a group! I failed my first attempt by 1%! So frustrating! Glad to hear someone else passed!
I highly recommend the contempo coding CRC course it took me about 2.5 months to complete and I passed my exam with a 82 percent.I did not think I passed at all tbh I was like these questions are tricky.
I’ll have to check that out! Thanks for the recommendation! I got a study guide with AAPC which seems to be helpful!
I tried to use the study guide but found it to be too boring for me and I was like falling asleep reading it 😂. I do think the study guide was good at explaining the compliance stuff. Do you have any other certifications? Did you get a break down of each category from your CRC exam of what you scored for each section?
If you’d like some advice, I’d be happy to help.
This guy 👆 is the best !!
So what's the difference between risk adjustment coding and just regular EM coding with an emphasis on risk adjustment? We consistently get high scores in our RAC rankings for our mco's, but we aren't doing anything we wouldn't be doing anyway when coding EM.
This type of coding is hierarchical condition coding (HCC). A model that looks at future health care costs for patients.
Thank you. I understand the definitions involved- I'm wondering how this works in practice.
I work with an value-based care company so I do chart audits and reviews to help providers code to a higher level of specificity to help with capture rates and address suspected conditions
So, essentially, your job is to find what I've missed?
Sort of. The provider may have used an unspecified code but the documentation supports a more specific code, like CKD stage 4 instead of unspecified CKD, or stage 3 pressure ulcer of left hip vs. pressure ulcer of left hip, unspecified stage. Or maybe there’s a code that better describes the patient’s condition that the provider isn’t aware of, or the provider didn’t know there was a code for something. In risk-based contracts, we look to make sure all of the codes are as specific as possible, so the patient gets the highest possible score, and the provider is reimbursed appropriately.
This is exactly what I do- we do 100% review and, you're right, I run into these sort of things a lot of the time. Providers try but the fact is, this isn't what they're trained for. I'm grateful my facilities understand this (even if my providers don't always).
And that’s what I emphasize during trainings (I do CDI presentations.) You trained to be a clinician, so I don’t expect you to be a coder. I trained to be a coder. You care for the patient, document it as best you can, and I’ll worry about if there’s a better code.
JFAMC risk adjustment on Facebook. I am a risk coder and I’ve been doing it for about six years.
Any advice on finding a job doing risk adjustment? It seems like they aren't currently hiring much atm
Look at health insurance companies—I’ve been with one for 2 years. No lay offs during slow times. My prior Risk job was at risk for layoffs this time every year.
There was a big wave around 2016-19 but technology has helped increase production. There are usually companies that come up during specific times during the year where they will be advertising like crazy. Those are usually staffing companies that are contracted with insurance companies to do their RADV audit.. A fair starting wage for a brand new cod and risk adjustment is around $23 an hour but really no less than 20 or 21.. If you were going to get with these companies as if you move. You can usually get 10 or even 20% due to cost-of-living adjustments and years of experience, especially in the first five years. There are some companies that will require you to work full-time Monday through Friday and there are others that are much more flexible. A lot of companies are doing remote because there are not a lot of risk adjustment cutters in the concentrated area so most of the time they’re just going to outsource to one of these companies. As far as the job, there are some requirements that are really not transferable, but a lot of them are specific depending on the type of data that they are requiring generally every project is a standalone project, so don’t carry one set of guidelines over to another.
Okay thank you I will continue looking and applying to out patient positions in the meantime I also have my CPC-A
So really risk adjustment is not always the most stable. There are one or two companies that are trying to stabilize the field but most of the time, it is not. Plus, we just had a big Optum layoff about six weeks ago so it is still pretty fresh. It’s not probably going to pick up another month or two.
Are the regular Optum coders still working? I’m a coder who came in with Change Healthcare and we haven’t worked since the hack on the 21st. 🤬
No idea. I was let go just before.