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Quality Improvement
Focused coursework on improving the quality and safety of clinical care and services provided to plan members.
Featured Course
Check out “Risk Adjustment 101". This course reviews the basics of risk adjustment and explains how it supports value-based care. Dive into risk scores and their calculations, documentation and coding techniques, and the importance of accuracy.
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HEDIS 101 for Healthcare Delivery Partners
Self-Paced Module | 25 minutes | Primary Care Providers
An introduction to Health Effectiveness Data and Information Sets (HEDIS).
- HIPAA and HEDIS
- What is HEDIS and your role in HEDIS?
- Annual HEDIS calendar
- HEDIS data collection
- Hybrid and administrative HEDIS measures and required documentation
Clinical Documentation Improvement: Angina
Self-Paced Module | 15 minutes | Primary Care Providers
A deep dive into the types of Angina, coding and clinical documentation improvement practices.
- Associated coding and documentation options for coronary artery disease with and without angina
- Clinical and model differences of stable and unstable angina
- Classification of current and resolved angina
- Supportive documentation for angina
Clinical Documentation Improvement: COPD
Self-Paced Module | 15 minutes | Primary Care Providers
A deep dive into disease states of COPD, specific coding, and documentation.
- Overview and studies of COPD
- Terms included and excluded with COPD
- Smokers Cough and COPD prevention
- Documentation of COPD and best practices
- Common coding options
- Clinical scenarios
Clinical Documentation Improvement and Coding - Diabetes Mellitus: The Basics
Self-Paced Module | 10 minutes | All Medical Providers
A deep dive into specific disease states and the changes that could result in significantly different revenue, the importance of coding to the highest level of specificity and the need for appropriate documentation within the medical record to substantiate the codes being billed.
- Classify types of diabetes
- Explain uncomplicated diabetes
- Identify complications of diabetes mellitus
- Review documentation best practices
Clinical Documentation Improvement: Chronic Kidney Disease
Self-Paced Module | 20 minutes | Primary Care Providers
A deep dive into specific disease states and the little changes that could result in significantly different revenue, the importance of coding to the highest level of specificity, and the need for appropriate documentation within the medical record to substantiate the codes being billed.
- Chronic kidney disease overview
- Diagnostic criteria
- Racial differences in clinical calculations
- Stage progression
- Chronic kidney disease ICD-10 coding options
- End stage renal disease
- Acute kidney injury on chronic kidney disease
- Documentation best practices
- Clinical scenarios
Clinical Documentation and Coding: High Risk Diagnoses and Audit Best Practices
Self-Paced Module | 20 minutes | All Medical Providers
A deep dive into high risk diagnoses and audit best practices.
- The Office of Inspector General
- Major Depressive Disorder
- Acute Stroke
- Vascular Claudication
- Cancer: Breast, Colon, Prostate, and Lung
- Acute Hearth Attack
- Acute Embolism
Clinical Documentation Improvement: Major Depressive Disorder
Self-Paced Module | 15 minutes | All Medical Providers
A deep dive into disease states of Major Depressive Disorder, specific coding, and documentation.
- Major Depressive Disorder overview
- Diagnostic criteria
- Single and recurrent episode
- Episode severity
- Documentation best practices
- Accurate and comprehensive ICD-10 coding
- Additional considerations
Clinical Documentation Improvement: Morbid Obesity
Self-Paced Module | 20 minutes | Primary Care Providers
A deep dive into specific disease states of Morbid Obesity, specific coding, and documentation including:
- An overview of morbid (severe) obesity
- Body Mass Index (BMI)
- Severe obesity with comorbidity
- Coding and documentation best practices
- Morbid obesity clinical documentation scenarios
Clinical Documentation Improvement: Primary Metastatic Malignancy
Self-Paced Module | 20 minutes | Primary Care Providers
A deep dive into specific disease states and the little changes that could result in significantly different revenue, the importance of coding to the highest level of specificity and the need for appropriate documentation within the medical record to substantiate the codes being billed.
- Important terms and definitions as they relate to accurate diagnostic code selection
- Cancer in the Medicare Risk Adjustment Model
- "Active" Cancer vs "History of"
- ICD-10-CM coding options and subcategories related to both primary and secondary malignancies
- Complications and comorbid conditions associated with cancer
- Documentation best practices
- Clinical scenarios
Clinical Documentation Improvement: Severe Asthma
Self-Paced Module | 20 minutes | Primary Care Providers
A deep dive into specific disease states and the little changes that could result in significantly different revenue, the importance of coding to the highest level of specificity and the need for appropriate documentation within the medical record to substantiate the codes being billed.
- Asthma overview
- Impacts of severe asthma
- Comorbid conditions
- ICD-10 coding options
- Documentation best practices
Clinical Documentation Improvement: Vascular Disease
Self-Paced Module | 20 minutes | All Medical Providers
A deep dive into specific disease states and the little changes that could result in significantly different revenue, the importance of coding to the highest level of specificity and the need for appropriate documentation within the medical record to substantiate the codes being billed.
- Risk Adjustment and Vascular Disease Overview
- HCC 108 Vascular Disease Overview
- Peripheral Vascular Disease
- Aortic Vascular Conditions
- Renal and Mesenteric Vascular Conditions
- Deep Vein Thrombosis
- Key Takeaways
Self-Paced Module | 20 minutes | Primary Care Providers
Review Risk Adjustment fundamentals and why it’s clinically important.
- Basics of risk adjustment
- Risk scores and their calculations
- Accurate documentation and coding techniques
- How risk adjustment supports the transition to value-based care
Self-Paced Module | 20 minutes | Primary Care Providers
Deep-dive into CMS Risk Adjustment methodology. Note: This is not an introductory course. Review our pre-requisite course Risk Adjustment 101 prior to completing this course.
- Elements of a risk score
- Documentation best practices
- Risk Adjustment data
- Links between documentation and auditing
- Data management in population health
Transitions of Care (TRC) and FMC (HEDIS) Star Measures
Self-Paced Module | 15 minutes | Primary Care Providers
Review the components of TRC and FMC HEDIS measures and the various requirements and workflows necessary to be compliant for the Star measures.
- Transitions of Care Star Measure
- FMC Star Measure
- Requirements to be compliant with the Star measures
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
Self-paced |15 minutes | All Medical Providers
An overview of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey with a focus on provider influenced CAHPS measures.
- Define CAHPS and explain its importance
- CAHPS measures
- Strategies to improve CAHPS performance
- CareFirst Resources
PDF | Primary Care Providers
A comprehensive guide on Quality Measures, Best Practices, Risk Adjustment, and more.