YES HIM Consulting, Inc. Your Consulting Firm for Auditing, Coding and Education

HCC

MEAT Criteria

HCC Chronic Conditions and M.E.A.T. Criteria

By Karen Youmans / January 13, 2020 / 0 Comments

As a follow-up to our previous articles “The HCC Coding Specialist: Benefiting payers, providers, and patients” and “HCC Medicare Advantage background and overview,” we now review HCC chronic conditions and the M.E.A.T. documentation criteria.

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ICD-11

ICD-11 Overview

By Karen Youmans / January 6, 2020 / 0 Comments

The World Health Organization (WHO) recently released the 11th edition of the International Classification of Diseases (ICD-11). This release was presented at the World Health Assembly on May 25, 2019 for adoption by member states, and will come into effect on January 1, 2022. However, note that it is still unknown when ICD-11 will be ready for implementation in the United States.

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Medicare Advantage

Medicare Advantage Insurers Use Reviews to Get Higher Payments

By YES HIM Consulting / December 20, 2019 / 0 Comments

An investigation by the Office of Inspector General (OIG) revealed Medicare Advantage insurers might be overstating patients’ diagnoses without the proper documentation to receive larger payments. Based on the 2016 Medicare Advantage encounter data analyzed by the OIG, insurers were able to get an extra $6.7 billion in payments in 2017.

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HCC risk adjustment

HCC Medicare Advantage background and overview

By Karen Youmans / October 16, 2019 / 0 Comments

As a follow-up to our previous article “The HCC Coding Specialist: Benefiting payers, providers, and patients” we now delve in deeper to the background and overview of HCC risk adjustment for the Medicare Advantage Program.

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