Medicare Advantage (HCC) Documentation: Connecting Clinical and Coding Concepts for Cancer and other Coding/Clinical Collisions

October 19, 2017

Coders and CDI staff are looking at the same elephant but from different ends: one holding the trunk, the other holding the tail. Dr. Taylor is both a clinician and coder, and understands the whole documentation elephant and will explain the differences and how to reconcile them. The Medicare HCC model is based on diagnosis capture of what is documented in the chart, and clinical indicators are necessary to support the code. This presentation will look at the cancer and other documentation dilemmas including cancer versus history of cancer, acute and chronic kidney failure, recent coding clinic changes including what’s up with “with”, depression, and substance use/abuse. We will unwrap difficult documentation challenges, learn the anatomy, physiology, and clinical classification, and then meld it all together with coding and documentation guidelines. Most importantly, Dr. Taylor will give you strategy and successful best practices he has used in educating the 1,000 doctors in his previous medical group so you will be able to navigate the coding, CDI, and clinical collisions.

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Learning outcomes

By the end of this webinar participants will be able to:

  • Understand coding, CDI and clinical perspectives to better collaborate code assignment in the cancer and other documentation difficult areas.
  • Understand better ways to have conversations and create query language to engage the doctor in a way that he/she will understand what and why you are attempting to clarify the information.
  • Understand the connection between the clinical and coding worlds and how those two perspectives weave into the CDI process.
  • Gain an understanding of the most commonly poorly documented conditions in the Medicare HCC realm and the “magic words” to teach to doctors so that they will understand specifically what to do.


Dr. Jim Taylor

Dr. Jim Taylor is a family physician, certified coder, and AHIMA approved ICD-10 trainer. After 10 years in full time private practice, he worked in the Medicare Advantage area for Kaiser Permanente for 15 years for a 1,000 physician group that had 95,000 MA members. He became a certified EPIC Physician Builder while at Kaiser. He now is the Medical Director for Medicare Risk at Iora Health. He is well versed in Medicare Advantage and has spoken extensively at AHIMA, AAPC, and HCCA conferences as well as authored articles about MA. To that end, he received the RISE Conference’s Martin Block Award for Clinical Excellence and Innovation. He has served as CMO for Colorado Access. He was on the board of directors for the Colorado Permanente Medical Group and served as the Chair for two years.

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