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 ...
Encourage physicians to value proper documentation and help them fulfill risk adjustment requirements and HEDIS scores. By Meera Mohanakrishnan, MS, CPC, COC, CPC-P, CRC, CPC-I, CCS, PAHM The medical record is evidence of a patient’s past and present health status and medical treatment. Quality documentation is necessary for accurate coding and billing. More significantly, it’s ...
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 ...