Posts Tagged ‘Medicaid’
Navigating the Maze: Similarities and Differences of Coding Medicare vs Medicaid Claims
Medicare and Medicaid offer seemingly similar coverage but present distinct coding requirements. This article serves as your guide, demystifying the similarities and differences between these essential programs and their respective coding guidelines.
Read MorePostpartum Insurance Coverage Period Extended to 12 Months in 4 States – Here’s How to Code the Expansion
CMS has expanded its Medicaid and Children’s Health Insurance Program (CHIP) coverage for postpartum care from 60 days to 12 months in California, Florida, Kentucky, and Oregon.
Read MoreEverything You Need to Know About the HCC Risk Adjustment Models
There are two different models for Hierarchical Condition Category (HCC) risk adjustments: the HHS-HCC model, which covers commercial payers of all ages and determines risk payments for the current year, and the CMS-HCC model for the Medicare Advantage program and those who qualify for Medicare or patients 65 and older.
Read MoreUpdates Coming to the Quality Payment Program in 2020
In the 2020 Medicare Physician Fee Schedule Final Rule released by the Centers for Medicare and Medicaid Services late last year, several changes were made to the value-based Quality Payment Program (QPP) to simplify the rules for providers. These updates will “impact more than 1 million clinicians eligible for one or both of the QPP’s two performance tracks, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). CMS estimates that 880,000 clinicians will be MIPS-eligible in 2020, and between 210,000 and 270,000 clinicians will achieve Qualifying APM Participant (QP) status in 2020.”
Read MoreNeed Medicare Learning Resources? The CMS Wheel Can Help
Navigating the Center for Medicare & Medicaid Services (CMS) rules can be tricky. It can be handy to have a fact sheet that goes over a variety of CMS topics. We recommend you use this interactive Medicare learning resource!
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