Healthcare Blog

The Basics of HCCs

Hierarchical Condition Categories (HCCs) are groups of diagnoses within disease categories that impact a patient’s risk adjustment factor (RAF) and reimbursement. HCCs help monitor the overall health status and predict the cost of care a patient is likely to receive based on the active conditions of that patient. The Risk Adjustment Payment Model is a […]

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Take the Risk Out of Risk Adjustment

With over 15 years of auditing experience, I have seen many changes in the world of healthcare reimbursement with focus shifting from volume to value. For years, I have been stressing the importance of ICD-10 specificity with supporting documentation. Where Medicare Advantage Plan beneficiaries are concerned, certain diagnosis codes fall into Hierarchical Condition Categories (HCC) […]

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Proposed Rule?

Here are some questions I have received when discussing the Proposed Rule with providers: Q. Why is CMS proposing these changes? A. CMS launched the “Patients over Paperwork” initiative in December of 2017 with the goal of cutting red tape and reducing burdensome regulations. The burden of proper documentation to support E&M code levels has […]

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Overview of Proposed Rule

The 2019 physician fee schedule proposed rule was released by CMS claiming historic changes that would increase the time that providers spend with patients and reduce the burden of paperwork. It has set off a wave of comments, many centered around the changes to E/M services. The changes to E/M are summarized as follows: •Collapsing […]

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Opioid Use Disorder

Based on the 2017 National Survey on Drug Use and Health, Mortality in the US 2016, an estimated 11.4 million people misused prescription opioids, 2.1 million developed opioid use disorders with 47,600 resulting in death from opioid overdose. This is over 30,000 more opioid overdoses than the 15,482 deaths related to heroin overdose. As such, […]

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Opioid Distribution

Combating the opioid crisis doesn’t stop at treatment and monitoring use as discussed in LHA’s post on Opioid Use Disorder, but continues with controlling the availability of the drug. According to the CDC, of the 11.4 million people who misused the drug, 53% obtained opioids from a friend or family member, 37.5% received them from […]

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New Medical Codes

Question: CMS came out with two new G codes this year: G2010 and G2012. How do we use the new codes and what documentation is required? Answer: G2010-Remote Evaluation of recorded video and/or images submitted by an established patient, including interpretation with follow-up with the patient within 24 business hours. The request must not originate […]

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MIPS Proposed Changes 2019

Over 90 percent of eligible clinicians participated in the Merit-Based Incentive Payment System (MIPS) during the first year of the Quality Payment Program (QPP). In order to succeed in future years, providers must optimize their practices workflows in order to report data appropriately and efficiently. Some areas of focus to consider are: • Templates for […]

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Let’s Talk EHRs

The implementation of an EHR into any healthcare organization is a complex process that requires proper preparation with dedicated attention to modifications in workflow. If adequate time is devoted to making this change then the system can be leveraged to enhance the quality of care given to each patient. Often organizations rely on the vendor’s […]

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Interesting Provider Questions!

Here are some frequently asked questions that have been coming up in conversation with our providers recently.Why do I have to write out my diagnosis when I put the ICD-10CM code in my note?Answer: Based on ICD-10CM, Risk adjustment auditing and HCC auditing guidelines, “The assignment of an ICD-10CM code is based on the providers […]

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