Last week, we distilled down CMS’s most recent 60-page proposal to revise the risk-coding system down to a couple of paragraphs. Today we look at how to take that information and get ahead of the curve? The first step is to back to your Sun Tzu in The Art of War—“They who try to control everything, controls nothing.” A given patient will be awarded a higher RAF score if...
Read MoreYou can be forgiven if you missed it among all your holiday frivolity, but CMS released a proposal for the latest risk-code update. It’s significant. And I read it so you don’t have to. The bottom line? If adopted, pay special attention to collecting all the HCC groups for your dual-eligible patients—that’s where the low hanging fruit is. Details: There are two proposed models under discussion—one that includes two additional conditions...
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Your coders and auditors are just as important as your clinicians. You’re getting paid on data. They’re the ones who validate the data. Have you let them know how important a role they play? You can do it in such a way that they won’t think they deserve more money. Create a “culture of compliance.” Let them know exactly how important such culture is to your organization. Make it an initiative regularly reportable to...
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Appropriately documented drug dependence codes are associated with increased risk codes and additional capitation payments. But it’s inappropriate to code them if you’re the one prescribing the medication in question. So, if you are managing your patient’s chronic pain with opioids, their heroin addiction with Buprenorphine or their adult ADD with amphetamines, then you cannot submit the corresponding dependence codes. These codes are very commonly submitted, often in error. The Recovery Audit Contractors know this....
Read MoreYour journey through the academy is complete, my mission objective fulfilled. But your mission is about to begin. To summarize: Your strategy Address, document and submit as many risk-based diagnostic codes as appropriate for each patient—all while staying reasonably sane. Your tactic Submit yourself to the idea that the common risk codes associated with specialty interventions—Acute MI, Stroke, Lung Cancer, will all be submitted without your...
Read MoreThe 21st Century Cures Act directed CMS to expand the risk-coding system to include additional mental health conditions. We talked before that these changes are evolutionary, not revolutionary, but they will give you the chance to gain some additional risk-based revenue. We also discussed how important it is to start coding these conditions now even though the changes are going to be phased in over three years starting in 2019. Experience...
Read MoreThe 21st Century Cures Act directed CMS to expand the risk-coding system to include additional mental health conditions. We talked before that these changes are evolutionary, not revolutionary, but they will give you the chance to gain some additional risk-based revenue. We also discussed how important it is to start coding these conditions now even though the changes are going to be phased in over three years starting in 2019. Experience...
Read MoreThe 21st Century Cures Act directed CMS to expand the risk-coding system to include additional mental health conditions. We talked before that, though these changes are not revolutionary, they will give you the chance to gain some additional risk-based revenue. We also discussed how important it is to start coding these conditions now, even though the changes are going to be phased in over three years starting in 2019. Experience teaches...
Read MoreLate last year, in response to the 21st-Century Cures Act, CMS released its proposed tweaks to the risk-coding system. They’re not huge, but they will make a difference. Especially if you incorporate the coding in your changes now and get ahead of the game. The most novel change involves your patient’s total disease burden. Starting in 2019, your patient’s overall risk score will be adjusted based on their...
Read MoreCMS has upped the ante on your data collection by tweaking the risk-coding system for 2019 and beyond in a significant way. By law, they were required to add Chronic Kidney Disease (CKD) stage 3 (ICD-10 N 18.3) to the list of risk code diagnoses. But in order to collect the additional revenue, you have to make sure you collect and submit the data appropriately. CKD3 is defined as an estimated or...
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