Posts Tagged ‘Medicare Advantage’
Webinar Recap for HCCs background and a deeper dive into M.E.A.T. Criteria
In conjunction with TruCode’s Educational Series of free webinars, YES President and CEO, Karen Youmans hosted a webinar focused on HCC education and coding, and the application of the M.E.A.T. Criteria. The webinar, which was held twice due to popular demand, was attended by over 3,000 HIM professionals. If you missed the opportunity to attend either session, you can download the presentation slides here. We will recap the main points made during the webinar, and provide additional resources to help you and your organization become HCC experts.
Read MoreTop 8 Changes Medicare Payment Systems Will See In 2020
The Centers for Medicare & Medicaid Services (CMS) is implementing 8 major changes this year to the Medicare payment systems, according to Becker’s ASC Review (2019). A majority of these changes come from the organization’s 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule (CMS, 2019). Other changes were due to the finalization of the CY 2020 Medicare Physician Fee Schedule Final Rule (CMS, 2019).
Read MoreChanges to Appropriate Use Criteria for Advanced Diagnostic Imaging
Starting January 1, CMS began testing the condition for Appropriate Use Criteria (AUC) requiring a qualified Clinical Decision Support Mechanism (CDSM) consultation by a qualified provider for payment on Advanced Diagnostic Imaging for Medicare beneficiaries. Claims must include the ordering professional’s NPI, which CDSM tool was utilized for the consultation, and “whether the service ordered would or would not adhere to consulted AUC or whether consulted AUC was not applicable to the service ordered” (Medicine Learning Network, 2018). The program will be fully implemented by January 1, 2021.
Read MoreMedicare Advantage Insurers Use Reviews to Get Higher Payments
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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