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AAPC’s RISKCON virtual conference prepares healthcare professionals for the future of reimbursement. What is risk adjustment? It’s a methodology that the Centers for Medicare & Medicaid Services (CMS) uses to compensate Medicare Advantage (MA) plans for the added costs of insuring people with chronic conditions. Sounds simple enough, but it’s not. Risk adjustment is complicated. […]
The post Unravel the Complexity of Risk Adjustment appeared first on AAPC Knowledge Center.
Uncommon diabetes complications and risk adjustment.
The post Factor in Uncommon Diabetes Complications for Risk Adjustment appeared first on AAPC Knowledge Center.
2020 has proven to be one of the most complex, busiest times in healthcare — in the 21st century, anyway. In January, we were preparing for a new chapter in ICD-10-CM, Chapter 21: Vaping-Related Disorders. On January 30, the World Health Organization announced a Public Health Emergency of International Concern (i.e., pandemic) for coronavirus. In […]
The post How Telehealth Services Factor Into Risk Adjustment appeared first on AAPC Knowledge Center.
Consistent with previous reporting, the Office of Inspector General (OIG) has added to its 2020 Work Plan a targeted audit of Medicare Advantage (MA) programs for risk adjustment diagnosis codes. This is not the first time federal agency has targeted risk adjustment data. The OIG stated back in 2017, “We will review the medical record […]
The post OIG to Audit Risk Adjustment Coding appeared first on AAPC Knowledge Center.
Providers no longer need to link documentation to diabetes mellitus for certain related conditions for coding; it’s implied. Medicare risk adjustment (MRA) coders identify active diagnoses that determine a patient’s level of risk (the likelihood of that patient needing medical care). This helps health plans project the cost of caring for their patient population. That […]
The post Guideline I.A.15: The One that Makes Risk Adjustment Coders Happy appeared first on AAPC Knowledge Center.
Can anyone point me in the right direction?
Thanks!
Has anyone heard this before? Is it true?
Bec we are in a rural area and not a lot of specialists here, we see a lot of complex patients. We are getting swamped with request for records from insurances, like 120 from BCBS, 80 from Humana, 50 from Aetna, etc.
We are drowning and had to pull resources to be able to comply with this requests.
I understand that it is in the contract that we should pull the records as requested but i think it’s unfair that the insurances are getting money from the government, and we are doing all the work.
Any thoughts?
I am looking for feedback and ideas from both providers and health plans on year end pushes to get coding gaps closed.
We have been working hard all year both on the plan side as well as the provider side to see members/patients, assess their chronic conditions, and get them documented & coded but as we all know it seems we always have more gaps to close!
I am looking for any ideas to try over the next 30 days that may help us exceed our goals in risk adjustment. I would love to hear some provider thoughts on what works best for you at the end of the year and how the plan can maybe assist you in getting members in or different strategies you may be trying.
Wishing you all a happy and safe holiday season!
Nicole Martin