Oct 1st, 2012
By Holly J. Cassano, CPC Accurate payment under the Centers for Medicare & Medicaid Services (CMS) risk adjustment reimbursement model depends on diagnosis code specificity and reporting all current chronic conditions. A leading cause of incorrect and/or insufficient reimbursement from Medicare Advantage (MA) plans is deficient hierarchal condition categories (HCC) code reporting. CMS has been ...
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 ...