HCC Blog by Caridad

For Payment Year (PY) 2014, Centers for Medicare and Medicaid (CMS) used a blended model when calculating risk score payments to health plans by taking 25% of the 2013 HCC Model 12 and 75% of the 2014 HCC Model 22. (HCC = Hierarchical Condition Coding)     Although it was expected that CMS would fully phase in Model 22 by PY2015, CMS announced in the Final Call Letter on April 7, 2014 that the HCC blended model would continue.   For PY2015, CMS will use a blended risk score for each member by taking 67% of the 2013 HCC Model 12 and 33% of the 2014 HCC Model 22 each appropriately normalized.   http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/downloads/Announcement2015.pdf     #HCC   Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contai

Major depressive disorder According to the American Psychiatric Association, major depressive disorder can be seen in patients who have suffered a depressive episode lasting at least two weeks, as manifested by at least five of the following symptoms: depressed mood, loss of interest or pleasure in most or all activities, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts about death or suicidal ideation. Major depression is highly recurrent, with recurrent episodes occurring in 50% or more of patients. Remission and recovery from major depression Whether or not a patient is being treated for depression (e.g., counseling and/or medication), remission can be defined as a level of depressive symptoms basically indistinguishable from that in someone who has never been depressed. When reporting history of major depressive disorder, instead of coding V1

The Centers for Medicare and Medicaid (CMS) offers web-based training courses that allow you to view and enroll in courses that are available to take online. Search Google for  ' cms.meridianksi.com' or try this link - CMS Web Based Training Register to create a free account. A learning catalog is available at: Medicare Learning Network-Autumn2014 Catalog It containts the latest edition of the MLN Catalog are listed all the products and services currently available through the CMS Medicare Learning Network®.  

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From: Scan Health Plan  http://hccublog.scanhealthplan.com/ Important Encounter Data Reminders and Updates Remember, effective July 2014, Medicare has implemented the 13 month processing window for timely filing of encounter data.   Encounters older than 13 months will receive an informational edit from CMS—but this will change to a reject, which could happen at any time. Remember, that your encounter must be processed by SCAN first, so it’s important that encounters be received in advance of that 13 month time limit.   We expect to receive notice from CMS prior to them beginning to reject encounters. Adjustments are not subject to the 13 month window,    but SCAN must submit them to CMS within 30 days of their adjudication.   Encounter Data Processing System Both the Risk Adjustment Processing System (RAPS) and the Encounter Data Processing System (EDPS) will be used in 2015.   CMS will make an announcement prior to discontinuing RAPS and moving to only EDPS for r