HCC Risk Adjustment Coding
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Documentation and Coding Practices for Risk Adjustment and Hierarchical Condition Categories
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May 13th, 2020
Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?
Published May 13th, 2020|
On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states: “Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...
April 15th, 2020
CMS Temporarily Suspends Contract-Level RADV Audits
Published April 15th, 2020|
The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.
April 13th, 2020
CMS Announces Final 2021 HCC Risk Adjustment Changes
Published April 13th, 2020|
On April 6, 2020, the Centers for Medicare & Medicaid Services (CMS) published their final Medicare Advantage (MA) and Part D payment methodologies for CY 2021. Read more to be prepared for these upcoming changes.
March 23rd, 2020
2021 Brings Another Risk Adjustment Calculation Change
Published March 23rd, 2020|
In 2021, a big change in Risk Adjustment score calculations will take place, which will affect payments to Medicare Advantage (MA) plans for the coming year and take us closer to quality and value-based programs instead of fee-for-service (FFS) or risk-adjusted (RA). Currently, CMS pays a per-enrollee capitated...
June 17th, 2019
Extrapolation Policies Apply to RAD-V Audits
Published June 17th, 2019|
Risk Adjustment is a program that was implemented to identify and support Medicare beneficiaries with health conditions, illnesses, or injuries that put them at risk of death or organ system/bodily function failure. Through Risk Adjustment (RA), Medicare ensures their beneficiaries are being followed at least annually for any healthcare conditions ...
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