HCC Blog by Caridad

In the Current Procedural Terminology (CPT) manual, Appendix G, it covers Medicare "Internet-Only Manuals" (IOMs). If you search in a web browser for IOM, you may find the Centers for Medicare & Medicaid Services (CMS) website where there is a section entitled "Medicare Managed Care Manual". This is an excellent reference that covers many aspects of the risk adjustment process. I have listed the links below: Internet Only Manuals :   https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs Internet Only Manual, Publication #100-16 entitled Medicare Managed Care Manual :   https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912 Internet Only Manual, Chapter 7 - Risk Adjustment , Medicare Managed Care Manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c07.pdf Once you reach this .pdf you may find this to be a great reference and s

This is the much anticipated CMS Risk Adjustment 2020 Model Software/ICD-10 mappings. The link is: https://www.cms.gov/Medicare/Health-plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/Risk2020.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending Then this is the link to find the mid year Final HCC diagnosis mappings: https://www.cms.gov/Medicare/Health-plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/Risk2020.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending Consider saving it to computer desktop for easy reference.

ICD-10-CM Official Coding Guidelines -  Supplement Coding encounters related to E-cigarette, or Vaping, Product Use Introduction  The purpose of this document is to provide official diagnosis coding guidance for healthcare encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI) . This guidance is consistent with current clinical knowledge about e-cigarette, or vaping, related disorders. As necessary, this guidance will be updated as new clinical information becomes available. The clinical scenarios described below are not exhaustive and may not represent all possible reasons for health care encounters that may be related to e-cigarette, or vaping, product use. Proposals for new codes that are intended to address additional detail regarding use of e-cigarette, or vaping, products will be presented at the March 2020 ICD-10 Coordination and Maintenance Committee Meeting. This guidance is inte

from the Medicare Learning Network a 4:54 minute video on "The Importance of Proper Documentation". Published Apr 17, 2018 be sure to follow  CMSHHSgov   on YouTube here is a link to the video on YouTube https://www.youtube.com/watch? v=10pmw4czf08   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.

I came across this excellent publication entitled THE EVER-GROWING COMPLEXITY OF RISK SCORE CALCULATION – 2019 & BEYOND by Gorman Health Group Topics covered : Risk Adjustment Overview Data Submissions      • RAPS      • EDPS      • Transitional Impacts Cures Act on Risk Adjustment 2019 Risk Adjustment Model Changes Cures Act on Risk Adjustment 2019 Risk Adjustment Model Changes highlights, slide 8: RAPS = Risk Adjustment Processing System Risk adjustment is the method used to adjust bids and payments to health plans based on demographics (e.g., age and gender) as well as actual health status of a plan’s enrollees. Medicare risk adjustment is prospective, meaning diagnoses from the previous year and demographic information are used to predict future costs and adjust payment. and on slide 10: EDPS = Encounter Data Processing System Encounter data is detailed data generated by healthcare providers, such as doctors and hospitals, which documents both the clinical

Today I am sharing a Risk Score Calculator found on SCAN - HCC University.  To use the calculator, there is a place to enter: date of birth, Demographic Risk Factors, Current Medicare Eligibility due to, Original Medicare Eligibility due to Disability and then the DX numbers. http://hccuniversity.com/risk-score-calculator/ I do not personally use it, but good to know there is an on-line calculator. I have included a sample below that was found on a Facebook HCC Risk Adjustment Group. 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

This .pdf has an excellent description of HCC Models, V12, V22, V23 Chronic Condition Data Warehouse – CCW User Guide: Medicare Risk Score Files July 2018 Version 1.0 P 8, Version 12 (V12) was available through 2014. P 9, Version V21, V22 https://www.ccwdata.org/ documents/10280/19002246/ccw- medicare-risk-score-user- guide.pdf It can also be found off the home page, look for Analytic Guidance tab > then CCW Medicare Risk Score Files User Guide I am not affiliated with them in any way. Just sharing a good explanation I came across.

1 995 DOCUMENTATION GUIDELINESFOR EVALUATION AND MANAGEMENT SERVICES as it relates to Risk Adjustment we can refer to page 2 of the document, GENERAL PRINCIPLES OF MEDICAL RECORD DOCUMENTATION 3 elements to evaluative statement about the diagnosis/disease should include: 1. assessment 2. clinical impression, or diagnosis 3. plan for care The patient's progress, response to and changes in treatment, and revision of diagnosis should be documented. and in the section:  DOCUMENTATION OF THE COMPLEXITY OF MEDICAL DECISION MAKING on page 12, "For a presenting problem with an established diagnosis the record should reflect whether the problem is: a) improved, well controlled, resolving or resolved; or, b) inadequately controlled, worsening, or failing to change as expected.  For a presenting problem without an established diagnosis, the assessment or clinical impression may be stated in the form of a differential diagnoses or as "possible,” "probable,”

Here is a web site that can assist with finding hospices that serve your area.  You can then compare them based on the quality of care they provide. Hospice agencies most often provide services where you live, whether it’s at home, an assisted living facility, or a nursing home. You can search by name and/or location. From an MLN Connects[R] for Thursday, February 28, 2019: https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/2019-02-28-eNews.html https://www.medicare.gov/hospicecompare/

Sharing this interesting article on coding productivity.  It discusses how many charts per hour or per day can be performed by an inpatient coder using ICD-10-CM/PCS ( Procedure Coding System)  American Health Information Management Association ( AHIMA )  is defining a “new normal” by establishing ICD-10-CM/PCS coding productivity benchmarks.   ICD-10-CM/PCS =  for hospital inpatient use only Will not replace CPT codes used by physicians Measuring and Benchmarking Coding Productivity: A Dec ade of AHIMA Leadership 24 inpatient records per eight-hour paid workday (20 min per records; three records per hour) 40 invasive procedure encounters per eight-hour paid workday (five per hour; 12 min per encounter or operative session) 120 emergency department coding per eight-hour paid workday (15 per hour; 4 min per encounter) 240 ancillary tests coding per eight-hour paid workday (30 per hour; two min per report or test) Glad to see they say sometimes the expectation likely ne