HCC Blog by Caridad

CMS calls this list "HCC number and brief description of disease/condition" https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2015-RiskAdj-FactSheet.pdf 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 contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

You can find HCC Codes in an Excel searchable format at the link below: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/Risk2017.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending Click on the 2017 Midyear Final ICD-10 Mappings, it will download. Open the folder and click on 2017 Midyear Final ICD-10-CM Mappings 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 contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

The HCCs by categories list is found here in the: Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter Found at: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf 79 categories of HCCs BY CATEGORIES P79-82 DISEASE COEFFICIENT AND LABEL 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 contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

Available through the Medicare Learning Network Publications  is the Chronic Care Management Series Changes for 2017 Fact Sheet.  this only applies to Medicare Fee-For Service Program also known as Original Medicare. Chronic Care Management Services Changes for 2017 ICN 909433 December 2016 Please note: The information in this publication applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). • What is CCM? Chronic Care Management (CCM) services by a physician or non-physician practitioner (Physician Assistant [PA], Nurse Practitioner [NP], Clinical Nurse Specialist [CNS], Certified Nurse-Midwife [CNM]) and their clinical staff, per calendar month, for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. Only 1 practitioner can bill CCM per service period (

"These educational resources explain topics such as billing, policy initiatives, and program updates. We review and update Publications every 12-18 months. They are free and may be printed. Search the list below for a topic or title, such as the MLN Suite of Products & Resources. You can also view the MLN Catalog to browse our educational resources by subject or product type." from the MLN Publications website. https://www.cms.gov/Outreach- and-Education/Medicare- Learning-Network-MLN/ MLNProducts/MLN-Publications. html The weekly MLN Connects newsletter gives updates on MLN Publications and Medicare program information.  The link to sign up can be found under the blue "MLN Catalog" button on the webpage. 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 bl

If the Disease Group is Listed in this column… …Then drop the Disease Group(s) listed in this column is found here : Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter Found at: https://www.cms.gov/Medicare/HealthPlans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf P 87 If the Disease Group is Listed in this column… …Then drop the Disease Group(s) listed in this column 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 contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of

This page contains ICD-10 codes in a searchable format by chapter. http://www.emedcodes.com/ browse/icd10-diagnosis-codes. html 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 contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

http://www.magnetmail.net/actions/email_mobile_web_version.cfm?recipient_id=2408638582&message_id=14643034&user_id=AHIMA&jobid=38455961#Top September 2017 HHS-RADV Audits for Benefit Year 2016: Part 2 By Monica M. Watson, RHIA, CPC, CCS, CCS-P, CPMA, CIC, CRC   This is Part 2 of a two-part series. The first article,  “An Inside Look at HCCs and Risk Adjustment Data Validation”  was published in the May 2017 issue of  CodeWrite .  As the autumn quickly approaches so does the 2016 initial validation audit (IVA) season, formally known as the Health and Human Services-operated Risk Adjustment Data Validation (HHS-RADV). This second year of the audits, the Centers for Medicare and Medicaid Services (CMS) has determined, will be another pilot year, allowing all parties to continue to work out the kinks and improve the process and outcomes. CMS spent the better part of the last few months listening to participants of the 2015 Benefit Year HHS-RADV and other key

https://www.magnetmail.net/actions/email_web_version.cfm?recipient_id=2408638582&message_id=14204985&user_id=AHIMA&group_id=0&jobid=37208444 May 2017 An Inside Look at HCCs and Risk Adjustment Data Validation: Part 1 By Monica Watson, RHIA, CPC, CCS, CCS-P, CPMA, CIC, CRC, and Sharon Easterling, MHA, RHIA, CCS, CDIP, CRC, FAHIMA Regulatory audits come in all shapes and sizes. From the Office of Inspector General (OIG) to Recovery Audit Contractors (RAC), to Zone Program Integrity Contractor (ZPIC), to Risk Adjustment Data Validation (RADV), each audit has a core objective: to ensure proper payments. The most common audits are coding audits and medical necessity audits, where the audit places the burden of proof on the claim’s submitter to demonstrate the coding is accurate and the condition is supported. Best practice encourages organizations to get it right before it goes out the door and incorporate monitoring through internal audit programs that mitigat

Centers for Medicare & Medicaid Services Risk Adjustment Data Validation (RADV) Medical Record Checklist and Guidance This is a two page document from CMS. The first page is a checklist and the second page provides guidance. When a condition is on the Problem list, that condition should be assessed in the chart and not just coded from the problem list without further documentation. With electronic health records (EHR) there is much information that is just forwarded into the next visit, we can only assume it is current and complete.  Adding new "free text" with information regarding that date of service is desirable. It is risky for medial coders to make assumptions that a particular medication on the chart was prescribed for an exact problem mentioned in the assessment.  Many times medications are prescribed for the side effect and not what it is typically used for.  We should try to avoid making our own conclusions on medications if not clearly referenced

Here is the list for Acceptable Physician Specialty Types for 2017 Payment Year (2016 Dates of Service) Risk Adjustment Data Submission.   Risk adjustment data needs to do done by one of types of providers on the list.   The link is: https://www.csscoperations.com/internet/cssc3.nsf/DocsCat/CSSC~CSSC%20Operations~Risk %20Adjustment%20Processing%20System~References~A95QD52430?open

I was introduced to these videos as the 2017 MCHC California Healthcare Conference ( www.coderclass.com ) Search on You Tube for Crash Course  and then Anatomy & Physiology they are very entertaining and information...and you thought that wasn't possible! you tube videos   https://youtu.be/rDGqkMHPDqE https://www.youtube.com/user/crashcourse Enjoy! 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 contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

CAPG Educational Series 2017: Quality Payment Program Webinars with CMS CAPG, the Voice of Accountable Physician Groups,  www.capg.org  has a phenomenal Education series, it is known as:   CAPG Educational Series 2017: Quality Payment Program Webinars with CMS (yes! a CMS representative is on the call!) http://www.capg.org/index. aspx?page=376 They are free and open to all. The next one is set for  Friday, July 7 , visit their website for details! I listened in on May's presentation, "How to Select Measures and Maximize Quality Performance in MIPS".  Although all this is new to me, I came away feeling I learned something.       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 contain references or links to statutes, regulations, or other policy materials. It is not

I am not sure how we can use this in coding for HCC, but I just found this web site exists, so I'm pretty excited about seeing what is available.  It is the ELECTRONIC CODE OF FEDERAL REGULATIONS it is part of the U.S. GOVERNMENT PUBLISHING OFFICE and can be found at  www.ecfr.gov The e-CFR is supported and maintained by the Office of the Federal Register (OFR), which is an office under National Archives and Records Administration (NARA), and the Government Publishing Office (GPO). from the Browse tab on left,  Title 42: Public Health  has information for the Medicare Advantage Program There are volumes 1 - 5, with volumes 2-5 dealing with "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES" It looks like all the legal E's having to do with Medicare it is said to contain the "Medicare Shared Savings Program Final Rule Overview, June 2015" just haven't found that on the webpage yet...