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Ins and Outs of HCCs

Author: Fernandez, Valerie

Source: Journal of AHIMA | Journal of AHIMA - Coding Notes

Publication Date: June 2017



A Hierarchical Condition Category (HCC) is defined as a risk adjustment model that is used to calculate risk scores to predict future healthcare costs. The Centers for Medicare and Medicaid Services’ (CMS) CMS-HCC model is used to predict healthcare spending for Medicare Advantage Pl....

How MACRA Changes HIM

Author: Marron-Stearns, Michael

Source: Journal of AHIMA

Publication Date: March 2017



The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is widely viewed as one of the most significant and complex changes to Part B Medicare reimbursement in several decades. The Centers for Medicare and Medicaid Services (CMS) created the Quality Payment Program (QPP) that incl....

CY 2017 OPPS Update

Author: Comfort, Angie

Source: Journal of AHIMA - Coding Notes | Journal of AHIMA

Publication Date: February 2017



As last year drew to a close, facilities began the looming task of reviewing the Hospital Outpatient Prospective Payment System (OPPS) final rule to ensure their chargemaster and systems were up-to-date with the 2017 changes. The final rule for calendar year (CY) 2017 was released on Novem....

Role of HIM in MACRA

Author: Primeau, Debra

Source: Journal of AHIMA - website

Publication Date: December 01, 2016




As providers gear up to meet reporting requirements under the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) new Quality Payment Program (QPP), health information management (HIM) stands to play a prominent role in the transition to value-based care.


Success un....

Moving Toward Value-Based Payment

Author: Easterling, Sharon

Source: CodeWrite

Publication Date: March 2016




As industry propels itself toward a shift in how providers are reimbursed, measured, and selected for care, providers have to be open, fluid, and deliberate in their plans over the next three years and beyond. The "CMS Quality Strategy 2016" was released by the Centers for Medicare an....

MACRA and the Role of Clinical Data Integrity

Author: Stearns, Michael

Source: Journal of AHIMA

Publication Date: January 2016



President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 on April 16, 2015. This legislation repealed the sustainable growth rate (SGR) but also introduced a number of provisions designed to compensate physicians and other healthcare professionals ba....

OIG Reveals Top Oversight Priorities for 2015

Author: AHIMA Advocacy and Policy Team

Source: Journal of AHIMA

Publication Date: March 2015

OIG's 90-page work plan for fiscal year 2015 (FY15) offers a high-level view of the office's continued monitoring of various HHS programs and initiatives, particularly those designed to ensure the appropriateness of Medicare and Medicaid payments. The work plan also outlines many of the government's activities in FY15 designed to ensure care quality and safety in hospitals and other healthcare settings.

Coding for Medicare Advantage Plans

Author: Truscott, Tricia

Source: AHIMA Convention

Publication Date: October 02, 2011


Background


The Centers for Medicare and Medicaid Services (CMS) use a reimbursement methodology similar to the DRG system for coverage of Medicare patients enrolled in Medicare Advantage plans through private insurance companies. Using ICD codes from hospital and physician visit....

Observation Services - Ensuring Every Dollar

Author: Canter, Kelly

Source: AHIMA Convention

Publication Date: October 02, 2011

Introduction

Inpatient medical necessity has become a very hot topic for the Recovery Audit Contractors (RACs) over the last 12 months. Due to the focus on medical necessity for inpatient admissions, proactive and reactive hospitals are scrutinizing their admission practices. Since there....

Health Information Exchange – Our Successes and Challenges with the Virtual Lifetime Electronic Record

Author: Foley, Teresa; Gillen, Zachary; Teal, Jennifer

Source: AHIMA Convention

Publication Date: October 02, 2011

Background

In the spring of 2009, President Obama announced plans to create a joint Virtual Lifetime Electronic Record (VLER) to improve care and services between the Department of Veterans Affairs (VA), Department of Defense (DoD), and the private sector. President Obama directed the Dep....

Three-Day Window Updates

Author: Garrett, Gail S.

Source: Journal of AHIMA - Coding Notes

Publication Date: June 2011


The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 was signed into law on June 25, 2010. One of its provisions revised the three-day payment policy, or the so-called "three-day DRG window."

This article highlights the changes to the three-da....

ICD-9-CM Coding Guidance for LTC Facilities. Appendix C: Regulatory Guidance for Reporting Diagnoses Related to Reimbursement

Author: AHIMA

Source: AHIMA practice brief attachment

Publication Date: October 2010


In August 2000, the HIPAA Transaction and Code Sets required the use of the ICD-9-CM code set. Subpart J, section §162.1002 Medical data code sets, states the adoption of the following code sets as standard medical data code sets:
ICD-9-CM, volumes 1 and 2 (including the "ICD-9-CM Official....

Payout: Reviewing Meaningful Use Payments

Author: Viola, Allison F.; Rode, Dan

Source: Journal of AHIMA

Publication Date: October 2010


CMS will pay meaningful use bonuses through three programs: Medicare Fee for Service (FFS), Medicare Advantage (MA), and Medicaid programs.
FFS Payments to Providers

For eligible professionals (EPs), understanding the payment system is especially important, because they must ch....

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