Daily Archives: October 14, 2020

Value-Based Care and Analytics: R=1

R=1. An almost unattainable feat in the world of statistical analysis. R, the correlation coefficient, is the measurement of how closely two variables are related. The closer the value of R is to one, the stronger the correlation. A value of one signals absolute correlation, which is why in a real world application, this value […]

Updates on MDPCP

The wait is over! The Maryland Primary Care Program (MDPCP) has been launched, 360 practices and their associated clinical transformation organizations (CTOs) are in performance year 1. The buzz is one of excitement mixed with some uncertainty. Maryland has been ready for a program that provides some financial capital to support care transformation and management […]

The World of EMRs & Coding

EMRs have wreaked havoc with clinical documentation. When educating providers, one of the most challenging things to explain is why it is important to write out their clinical impression instead of depending on the diagnosis drop down menu. When they see the results of their audit, they are often confused as to why I have […]

The Three T’s of an Office Move

Recently, we moved our office 1.3 miles down the road. This move, though not sizable in distance, forced us to change zip codes and phone numbers. But that was only the beginning. I was put in charge of the office move, and, going into the experience, I had no idea how many pieces there would […]

The Importance of Specificity in Coding

Hierarchical condition categories (HCCs) utilize ICD-10 codes to determine risk scores for patients. Each applicable HCC is added up to determine the patient’s total risk adjustment factor (RAF). It is imperative to code with as much specificity as possible, in order to fully encapsulate the amount of resources expected to be needed for the patient. […]

The Growing Need for CDI

Clinical Documentation Improvement is not new in the healthcare world. In fact, the process has been occurring in hospitals around the country for decades. Traditionally, the role of CDI professionals has been to act as a liaison between providers and inpatient coders since communication between these two parties can often be difficult as they typically […]

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 […]

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) […]

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 […]

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 […]