HCC Blog by Caridad

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 dat...

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 Yea...

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 med...