Aug 1st, 2012
By Holly J. Cassano, CPC Proper hierarchal condition category (HCC) classification depends on a plan’s ability to obtain accurate diagnostic HCC information and report that information accurately to the Centers for Medicare & Medicaid Services (CMS). If a plan focuses solely on disease management to decrease costs (neglecting to develop an effective HCC strategy), it ...
Feb 1st, 2011
Big changes to PQRI in 2011 put pay for performance in the spotlight. By Penny Osmon, BA, CPC, CPCI, CHC, PCS Updates to the Physician Quality Reporting Initiative (PQRI) signal that the shift from pay for reporting to pay-for-performance has begun. The 2011 Physician Fee Schedule final rule, issued Nov. 2, 2010 by the Centers ...
In Billing
Sep 10th, 2010
Several technical and typographical errors have been identified in the 2011 Medicare Part B Physician Fee Schedule (MPFS) proposed rule since its July 13 release. Although the corrections the Centers for Medicare & Medicaid Services (CMS) subsequently posted Aug. 22 in the Federal Register do not constitute rule-making, some of the changes are worth noting. ...
May 1st, 2010
By Laura Smith, CPC, CPC-I In 1997, Congress passed the Balanced Budget Act (BBA), which mandated risk adjustment methods to improve payment accuracy. Where previously CPT® codes drove payment, diagnosis codes and accurate documentation became the determining factors. As such, it became even more important for providers to sharpen their documentation proficiency and coders to ...