In CMS
Apr 13th, 2018
The Centers for Medicare & Medicaid Services (CMS) put on display April 9 a rule that finalizes several proposed changes that will significantly expand the role of states in the administration of the Patient Protection and Affordable Care Act (PPACA), with the intention to reduce regulatory burden and increase flexibility. Background of the PPACA President Obama ...
Help physicians fill in the missing information when they use visual cues to determine a diagnosis. Most coders are familiar with the coding and documentation guidelines required to support the management of hierarchical condition categories (HCCs); for certain conditions, however, physicians may use visual cues to decide whether the patient’s diagnosis is appropriate. This can ...
In Billing
Feb 2nd, 2018
Small group and individual markets have unique strategic opportunities for coding and operational processes. Risk adjustment is predictive modeling that assesses members’ risk for incurring medical expenses above or below the average during a defined time. Demographics and health status are used to determine health plan payments, which also can assist with care management needs. ...
Medical groups and health systems that are members of the American Medical Group Association (AMGA) estimate that 60 percent of their Medicare revenues will be risk-based in 2019, pointing to a greater need for risk-assessment coders. Fierce Healthcare reports respondents to the organization’s annual risk survey said they expect revenues from Medicare Advantage to equal ...
With understanding comes proper reimbursement and compliance. Hierarchical category condition (HCC) coding is the risk model that the Centers for Medicare & Medicaid Services (CMS) uses to determine the acuity of Medicare Advantage (MA) patients. It is a major factor influencing reimbursement for patients. Despite its importance, the methodology is not well known among physicians. ...