Risk adjustment is a method to offset the cost of providing health insurance for individuals—such as those with chronic health conditions—who represent a relatively high risk to insurers. Under risk adjustment, an insurer who enrolls a greater-than-average number of high-risk individuals receives compensation to make up for extra costs associated with those enrollees. In the […]
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Tag Archives: Adjustment
Training Is Key to Risk Adjustment Success
Meet the needs of payment model programs through provider training. By Mary E. Wood, CPC, CPC-I Risk adjustment payment models have become more common, but the various programs do not have cohesive or consistent guidelines. Let’s consider the educational needs this creates in your facility or practice, and steps you can take to meet those […]
AAPC Knowledge Center
Medicare global adjustment denial code
Over the last several months, our billing department has received denials for global adjustment for labs and radiology performed same day claimed under outpatient hospital. The vast majority of these are Nursing home claims that share the facility with the hospital. They have asked for assistance in correcting these. Has anyone else noticed this trend, and could help shed some light on this for us.
Thank you in advance.
Thank you in advance.
Use of Z45.42 as principal diagnosis for the adjustment of a neurostimulator
Does anyone have insight on the use of ICD-10 Z45.42 as a principal diagnosis for a vagus nerve stimulator adjustment? The reason for the encounter is the adjustment of the neurostimulator for a patient who has (or had intractable seizures). CMS only covers intractable partial seizure diagnoses but if the device already implanted and is working I would believe you would use Z45.42 in position 1 and the epilepsy diagnosis code in position 2. The problem is if the patient is no longer intractable then you can’t use a covered CMS diagnosis code to manage patients who have controlled their seizures though the use of an already implanted VNS Therapy system. I would be interested in what the AAPC membership thinks about the issue. Many thanks!
Pace Yourself in 2017 to Avoid Negative Payment Adjustment in 2019
The physician community has been in a bit of a tizzy since April, when the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking for implementing its Quality Payment Program (QPP) — and with good reason. The expectation for eligible clinicians to begin performance reporting at the start of 2017, or […]
AAPC Blog
FAQ: 10 Things You Need to Know about Risk Adjustment
Providers who hire Certified Risk Adjustment Coders (CRCs™) have nothing to fear. The risk adjustment methodology is a relatively new payment model that is prospective in nature — meaning that healthcare costs in future years are based on what is known to be true of healthcare costs in recent years. Providers that hire CRCs™ have […]
AAPC Blog