HCC Blog by Caridad

 Billions in Estimated Medicare Advantage Payments From Diagnoses Reported Only on Health Risk Assessments Raise Concerns https://oig.hhs.gov/oei/reports/OEI-03-17-00471.asp OIG analyzed 2016 MA encounter data to determine the 2017 financial impact of diagnoses reported only on HRAs and not on any other records in the encounter data that year. Most in home HRAs were conducted by companies that partner with or are hired by MAOs to conduct these assessments-and therefore are not likely conducted by the beneficiary's own primary care provider. Twenty MAOs generated millions in payments from in-home HRAs for beneficiaries for whom there was not a single record of any other service being provided in all of 2016. Complete 45 page report can be found at:  https://oig.hhs.gov/oei/reports/OEI-03-17-00471.pdf

This was issued in response to the COVID-19 pandemic This 'Dear Clinician' letter from CMS was dated April 7, 2020.   This is just for historical reference and they published clinical guidance on a daily basis for many months since then.   Medicare Telehealth Visits:           p 3 Virtual Check-ins:                         p 4 E-visits:                                         p 4 Waiver 1135                                   p 8 Dated 4/7/2020 https://www.cms.gov/files/document/covid-dear-clinician-letter.pdf

Model diagnosis codes are found here: https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors Past models include: 2017 CMS-HCC PACE/ESRD Model V21          CMS-HCC Model V 22 2018  CMS-HCC PACE/ESRD Model V21         CMS-HCC Model V22           79 HCC Codes 2019  CMS-HCC PACE/ESRD Model V21          CMS-HCC Model V22 & V23   2020  CMS-HCC PACE/ESRD Model V21 &         CMS-HCC Model V22 & V24 CMS.GOV Model Software/ICD-10 Mappings Once at the website, in the search box:   2018 ICD-10 Mappings If you search for 2019 ICD-10-CM, look for a result that says WITH CODING GUIDELINES, CODE TABLES AND INDEX search box:  2018 ICD-10 Mappings, 2nd page in results is 2018 ICD-10 CM and GEMSs WITH CODING GUIDELINES, CODE TABLES AND INDEX compiled Aug 2020 Disclaimer: This guidance is to be used for an e...