rmwinder's latest activity

  • rmwinder
    rmwinder replied to the thread The use of MEAT.
    It is in my opinion. :) Where I work, it is.
  • rmwinder
    However, you would code the CHF if this was an inpatient record. And even in an Outpatient setting, CHF is seldom just resolved - although if definitely can be resolved. If you have a way to query your doctor, ask if the CHF exacerbation is...
  • rmwinder
    Certainly. That's why we are certified to catch those sort of things. In that scenario, you'd definitely delete the one and capture the correct one. I am in no way saying just capture everything in the A/P and be done with it. 1. If no support...
  • rmwinder
    Thanks for the Coding Clinic! I actually have access to the Coding Clinics back through 2014, and I agree, the providers may not just list the Alpha-Numeric code in the diagnostic statement. In other words...they cannot just put E11.36 in the...
  • rmwinder
    Is there any way you can supply the AHA Coding Clinic you are referring to?
  • rmwinder
    DM is one With EMR's being the 'norm' now the following snip I've included is what you'll come across a majority of the time. What makes it acceptable is the Description column. We all know we cannot confirm a diagnosis code by the code...the...
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  • rmwinder
    rmwinder replied to the thread HCC Trump List.
    Hey Amy! Yes, I believe that is what they are asking for.
  • rmwinder
    rmwinder replied to the thread Question HCC 140 Renal Failure.
    For PY (Payment Year) 2019, See page 86 for Disease Trumping List https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2019.pdf
  • rmwinder
    rmwinder replied to the thread Question HCC 140 Renal Failure.
    Hi Myla, Yes, I am an Auditor for a large payer, working strictly in Medicare Risk Adjustment. What would you like a source for? CMS info in general, or the Hierarchy chart? Here's a link to the CMS Managed Care Info file. Chapter 7 is Risk...
  • rmwinder
    @Pathos as it happens, I am not entirely comfortable with my responses. I am still looking into this too. In fact, I know I had the RADV audit rules document somewhere, and was trying to find time to see if there was any further guidance in...
  • rmwinder
    rmwinder replied to the thread Question HCC 140 Renal Failure.
    Anemia in CKD - D63.1 doesn't risk adjust, so there's no need to pick it up unless you're doing full capture. ESRD - N18.6 (HCC 136) instructs to also capture the dependence on dialysis, like you have above - Z99.2 (HCC 134) Z99.2 actually trumps...
  • rmwinder
    rmwinder replied to the thread Medicare & Naturopathic.
    They aren't recognized because they don't deal in real medicine.
  • rmwinder
    rmwinder replied to the thread Risk Adjustment Chart Review.
    Most MA plans do have record retrieval specialists too. I wonder if they could go onsite to retrieve the records?
  • rmwinder
    rmwinder reacted to mcwriter's post in the thread Risk Adjustment Chart Review with Like Like.
    Payer burden I would strongly encourage providing space for reviewers to work onsite (give them a desk and a decent lamp) or even better provide electronic access with a secure server to eliminate the burden of pulling and copying records. Good...
  • rmwinder
    rmwinder reacted to rsb2918@aol.com's post in the thread Risk Adjustment Chart Review with Like Like.
    Obviously the higher the patients risk score is the sicker they are. The insurance companies are then in turn putting out more money for these patients. If the chronic diagnoses are NOT being captured but the patient is still requiring these...
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