In Audit
Aug 27th, 2019
The Centers for Medicare & Medicaid Services (CMS) knows that a significant amount of money is being overpaid to insurance companies in the Medicare Advantage program, but they have yet to recover these overpayments. That’s about to change. CMS says it will increase the audits being performed on Medicare Advantage risk-adjusted code submissions and apply ...
In Audit
Jul 24th, 2019
AAPC’s Regional Conference in New York City (Aug. 19-21) is a must for anyone who works in the business of healthcare such as medical coders, billers, and auditors. There will be opportunities galore for education, networking, vendor resources – all at a venue that can’t be beat. This year’s lineup of speakers includes Marianne Durling, ...
In CMS
May 29th, 2019
The Programs of All-inclusive Care for the Elderly (PACE) recently got a boost from the Centers for Medicare & Medicaid Services (CMS) final rule that modernizes the program to the “latest standards of in caring for PACE participants.” PACE Serves 45,000 PACE provides comprehensive medical and social services to certain frail, older folks who qualify ...
In CMS
Apr 23rd, 2019
Beginning January 2020, primary care practitioners may qualify to participate in one of five new payment model options that focus on supporting care for patients who have chronic conditions and serious illnesses. The Centers for Medicare & Medicaid Services’ (CMS) Primary Care Initiative is a new set of payment models that will provide primary care ...
In Coding
Apr 1st, 2019
Documentation is key to correct ICD-10-CM coding, better patient care, and proper reimbursement. Physician documentation is one of the most important keys when abstracting for hierarchical condition category (HCC) coding. In a value-based payment system, documentation — more specifically, coding extracted from that documentation — determines whether a physician is properly compensated for managing ...