Posts Tagged ‘risk adjustment’
“Does Your Documentation Meet the M.E.A.T. Criteria?” Presentation by Karen Youmans at 2021 Southeastern Health Data & Information Conference
“Does Your Documentation Meet the M.E.A.T. Criteria?” Presentation by Karen Youmans at 2021 Southeastern Health Data & Information Conference (Quad21) Karen Youmans’ presentation at the Quad21 (Southeastern Health Data…
Read More“Does Your Documentation Meet the M.E.A.T. Criteria?” Presentation by Karen Youmans at 2021 FHIMA Annual Convention
“Does Your Documentation Meet the M.E.A.T. Criteria?” Presentation by Karen Youmans at 2021 FHIMA Annual Convention Karen Youmans’ presentation at the 2021 FHIMA Annual Convention will focus on the…
Read MoreYour Quick Guide to HCC Risk Adjustment Models
There are two different Hierarchical Condition Category (HCC) models used to calculate risk adjustments: the CMS-HCC model and the HHS-HCC model. Does your facility know how and when to use them? Our detailed HCC risk adjustment infographic explains the differences and usages for each HCC model.
Read More2022 Medicare Advantage Advance Notice Changes Process for Risk Adjustment Scores
CMS has released Part 1 of the 2022 Medicare Advantage Advance Notice, which reviews the updates to the Part C CMS-HCC risk adjustment model and the application of encounter data (CMS, 2020). Changes to the CMS Advance Notice are scheduled to be finalized by April 5, 2021. HCC coding and risk adjustments are one of YES HIM Consulting’s many specialties. The Risk Adjustments & HCC Basics learning path from YES HIM Education provides an overview of the HHS and CMS risk adjustment models, documentation, coding practices, and much more.
Read MoreArtificial Intelligence, Natural Language Processing, & Experienced Coders – Accurate Risk-Adjusted Payments
On average, organizations managed 9.70 petabytes (PB) of data in 2018; this is an explosive growth of 569 percent compared to the 1.45 PB managed two years prior (Dell Technologies, 2019). Healthcare organizations are no different, in fact, according to HIT Infrastructure (2019). Healthcare organizations have seen a health data growth rate of 878% since 2016, reaching 8.41PB on average by 2018. As you can imagine, it is physically impossible for a human to read through and analyze the tremendous amount of data collected. Healthcare organizations are rapidly turning to Artificial Intelligence (AI) and Natural Language Processing (NLP) to help collect, transform, understand, and drive decisions in a timely manner.
Read MoreWebinar 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 MoreCMS Increases List of Payable Medicare Telemedicine Services
Adapting to the influx of telehealth services in response to the COVID-19 outbreak, CMS has adjusted the “List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth” in order to provide as much support and care as possible (2020). In addition, CMS issued updated criteria for risk adjustment of Medicare telemedicine services, as well as guidelines on how to bill for telemedicine.
Read MoreCMS Clarifies Risk Adjustment Criteria for Coding Telehealth Services
CMS clarified on April 10, 2020, that the submission of ICD-10-CM diagnoses codes for Risk Adjustment are permitted from coding telehealth services as long as it meets the set criteria (i.e. inpatient, outpatient, or professional service and from a face-to-face encounter) (CMS, 2020). CMS is stating that telehealth services can meet the face-to-face requirement “when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication” (2020). From a medical coding and billing standpoint, the change in the telehealth services criteria for risk adjustment is causing updates to how these services are billed.
Read MoreHCC Chronic Conditions and M.E.A.T. Criteria
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.
Read MoreHCC Medicare Advantage Background and Overview
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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