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   This is just for historical reference and they published clinical guidance on a daily basis for many months since then.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...

Hello, I am sharing this post from the National Kidney Foundation of eGFR & CKD. Below is a snip of the first page, but click on the link for the rest of the information. Happy coding! https://www.kidney.org/atoz/content/gfr?deliveryName=USCDC_974-DM21518

I came across two reference for coding for COVID-19 and am sharing them below: Frequently Asked Questions Regarding ICD-10-CM Coding for COVID-19 American Hospital Association This is an easy to read reference for coding for COVID-19 https://www.aha.org/fact-sheets/2020-03-30-frequently-asked-questions-regarding-icd-10-cm-coding-covid-19 and a reference sheet from the CDC ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020 https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf For history of COVID-19, consider Z86.19,  Personal history of other infectious and parasitic diseases 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 t...

This is the web page for the Office of Inspector General (OIG) Active Work Plan Items. There are links to the 'Work Plan Home', 'Recently Added' and 'Work Plan Archive' There is also a blue button to Download the Work Plan. This provides the name and number of the reports. It is a great page to have bookmarked and check periodically. https://oig.hhs.gov/reports-and-publications/workplan/active-item-table.asp --------- Another great page to check out periodically is the OIG's page for Fraud is located here: https://oig.hhs.gov/fraud/strike-force/ Give information on their latest's efforts to curb Medicare Fraud. 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...

Centers for Medicare & Medicaid Services (CMS) is further expanding Medicare patient's access to telehealth services by implementing the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act. This post covers the third portion of this act: 3) increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home Further Expand Telehealth in Medicare "CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020." ...