by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA In December I posted a blog after reading Merrill Goozner’s GoozNews on CMS’s proposal to adopt a common prior authorization form. I agreed with Merrill when he stated that the proposal was problematic in that it did not apply to Medicaid or to the rapidly growing […]
read more »by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA Information in this article has been revised here. An excellent column in the excellent newsletter by Merrill Goozner, GoozNews, has hit the nail on the head. The article describes CMS’s recent proposal to require insurers adopt a common prior authorization form and switch to fully […]
read more »by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA At the end of last year, this news may not have caught your attention: Federal Auditor Renews Concerns of Medicare Advantage Gaming Axios, December 12, 2019 “A new federal audit presents more evidence that private Medicare Advantage plans are fudging the data about how sick […]
read more »by Rose T. Dunn, MBA, RHIA, CPA, FACHE In case we need another reason to stand firm when documentation and/or coding become questionable, we are reminded that not only is it our duty, we may be subject to financial penalty if we do not. Earlier this year, Becker’s identified the failure of Medicare Part C […]
read more »by Rose T. Dunn, MBA, RHIA, CPA, FACHE The last few weeks have been busy ones for those of us who work in Hierarchical Condition Categories (HCC) coding. CMS made three major announcements. Let’s look briefly at each. Changes to the Coefficient Calculation For 2022, the coefficient calculation will be based solely on encounter data […]
read more »Hear Rose T. Dunn, MBA, RHIA, CPA, FACHE, a nationally recognized HCC expert, provide a free, brief presentation: “Hierarchical Condition Categories: The Roles and Responsibilities of the Internal Auditor.” HCC: Auditing in the Risk Adjustment Environment The essential information internal HCC auditors need to ensure their organization receives the reimbursement they are entitled to […]
read more »Hear Rose T. Dunn, MBA, RHIA, CPA, FACHE, a nationally recognized HCC expert, provide a free, brief presentation: “Hierarchical Condition Categories: Auditing in the Risk Adjustment Environment: The Auditor’s Role.” HCC: Auditing in the Risk Adjustment Environment The essential information internal HCC auditors need to ensure their organization receives the reimbursement they are entitled […]
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by Rose T. Dunn, MBA, RHIA, CPA, FACHE A recent article in Becker’s Hospital CFO Report entitled “Hospitals Overbilled Medicare $1B by Upcoding Claims, Inspector General Finds” caught my attention. The specific finding by OIG is that assignment of diagnosis codes for severe malnutrition to inpatient hospital claims (when they should have used codes for […]
read more »by Rose Dunn, MBA, RHIA, CPA, FACHE, FHFMA In response to my recent article “Using Telehealth to Mitigate the Impact of COVID-19 on your HCCs,” we received the following question. …We need information related to capture of HCC’s with telehealth visits, during and after the pandemic. In the past there seemed to be a limitation […]
read more »by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA If you are wondering whether the documentation for a patient seen in the emergency department is relevant to HCC coding, the answer is an emphatic Yes! In fact, claims from the emergency department and any other outpatient hospital department qualify for HCC capture. These outpatient […]
read more »by Rose Dunn, MBA, RHIA, CPA, FACHE, FHFMA In addition to the terrible human cost of the COVID-19 virus and the general impact it is having on the healthcare industry, there are two ways in which the pandemic may affect your HCCs. With people being told to stay home, the reduced number of visits to […]
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by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA I recently received an inquiry from a coder and she provided the following image: Click to enlarge The coder wanted to know why the same ICD-10-CM code would map to two different HCC codes. This is a great question! There are over 10,000 […]
read more »by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA One unique aspect of HCC coding is that it requires provider documentation of HCC conditions each calendar year. As the holidays approach, we need to remember the annual HCC “reset” will be upon us January 1. Now is the time to prepare for the New […]
read more »by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA As we all know, thorough and complete documentation is essential to support Hierarchical Condition Category (HCC) coding. But how do we know when the documentation is enough? I am seeing alarming reports of auditors rejecting HCC diagnoses based on what they are claiming is insufficient […]
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by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA We recently received a question regarding the use of problem lists to support HCC diagnoses: My question is regarding the documentation source for Inpatient. “Problem Lists’ are not considered a source to get the documentation, is that correct? Is there a website I can go […]
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Hear Rose T. Dunn, MBA, RHIA, CPA, FACHE, a nationally recognized HCC expert, provide a free, brief presentation: “Introduction to HCC Coding: External Auditors: IVA vs RADV.” Fundamentals of HCC Coding Learn more from Rose! Go beyond just the diagnoses — really understand the methodology behind HCCs with the course “Fundamentals of HCC Coding.” […]
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Hear Rose T. Dunn, MBA, RHIA, CPA, FACHE, a nationally recognized HCC expert, provide a free, brief presentation: “Intro to HCC Coding: Documentation Guidelines.” Fundamentals of HCC Coding Learn more from Rose! Go beyond just the diagnoses — really understand the methodology behind HCCs with the course “Fundamentals of HCC Coding.” Learn more […]
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Hear Rose T. Dunn, MBA, RHIA, CPA, FACHE, a nationally recognized HCC expert, provide a free, brief presentation: “Intro to HCC Coding: Risk Adjustment Factor.” Fundamentals of HCC Coding Learn more from Rose! Go beyond just the diagnoses — really understand the methodology behind HCCs with the course “Fundamentals of HCC Coding.” Learn more […]
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Hear Rose T. Dunn, MBA, RHIA, CPA, FACHE, a nationally recognized HCC expert, provide a free, brief presentation: “Introduction to HCC coding: Related vs. Unrelated.” Fundamentals of HCC Coding Learn more from Rose! Go beyond just the diagnoses — really understand the methodology behind HCCs with the course “Fundamentals of HCC Coding.” Learn more […]
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Hear Rose T. Dunn, MBA, RHIA, CPA, FACHE, a nationally recognized HCC expert, provide a free, brief presentation: “Introduction to HCC coding: What are HCCs? Importance of Specificity.” Fundamentals of HCC Coding Learn more from Rose! Go beyond just the diagnoses — really understand the methodology behind HCCs with the course “Fundamentals of HCC […]
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