HCC Blog by Caridad

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, regulatio...

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 ye...

Office of Inspector General Policy Statement Regarding Gifts of Nominal Value To Medicare and Medicaid Beneficiaries Did you know that the Office of Inspector General (OIG) has a policy that limits gifts to Medicare and Medicaid Beneficiaries?  Well, they do.  It can be found at: https://oig.hhs.gov/fraud/ docs/alertsandbulletins/OIG- Policy-Statement-Gifts-of- Nominal-Value.pdf It is against policy of the Social Security Act to give a gift that is  "likely to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of Medicare or Medicaid payable items or services"  So you can't give out money to get a beneficiary to chose to go to your practice or to your doctor.  This also means you can't waive copayments and deductibles or give them items or services for free.  They do, however, allow you to give "inexpensive gifts of nominal value be permitted".  They give the definition for "nominal value" as hav...

Low-Cost CEUs Here is an opportunity for certified coders to obtain low-cost or free Continuing Education Units (CEUs): CMS - Medicare Learning Network has several web-based training programs. Make a free account at https://learner.mlnlms.com/Default.aspx

ICD-10-CM Official Guidelines for Coding and Reporting FY 2016 "The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).  These guidelines should be used as a companion document to the official version of the ICD-10CM as published on the NCHS website. The ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings.  The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO). " These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions...