Feb 9th, 2018
The Boston-based nonprofit health system, Partners HealthCare System, Inc., discovered personal data and protected health information (PHI) had been accessed by computers infected with malware in May 2017. The breach involved more than 2,600 individuals of which Partners notified on Feb. 5. According to Boston Business Journal: The nonprofit health system, whose hospitals include Massachusetts ...
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 ...
In Audit
Nov 22nd, 2017
The Office of Inspector General (OIG) is recommending Rush University Medical Center, Chicago, Ill., refund $10.2 million in Medicare overpayments based on an audit sample of 120 inpatient and outpatient claims. Rush allegedly did not fully comply with Medicare billing requirements for 57 of the claims, resulting in overpayments of $814,150 for the audit period (2014-2015). The OIG ...
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. ...