HCC Blog by Caridad

Have you ever wondered what career opportunities are available with the Federal Government in the Office of the Inspector General? Well here is a link to the website to check that out from time to time! OIG Careers USAJOBS.GOV https://oig.hhs.gov/careers/

 Here are some highlights from the press release: The government alleged that BioTelemetry — with the knowledge of then senior management — diverted certain federal beneficiaries’ ECG Data to India when the domestic workflow became backlogged. “Federal health care beneficiaries deserve care, including remote cardiac monitoring, that complies with federal law and is provided by qualified clinical personnel,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Today’s settlement reminds all providers that they must observe those standards and reflects the department’s commitment to pursue knowing violations of federal health care program requirements.”  The United States further alleged that most of the offshore technicians tasked with reviewing ECG Data for federal healthcare program beneficiaries did not have the basic qualifications to perform the tests in question.  In connection with the settlement, BioTe...

This Risk Adjustment 101 program is designed for individuals who are either new to the risk adjustment process or desire a refresher of the basics.  The primary audience for this program includes:  Medicare Advantage (MA) and Medicare Advantage-Prescription Drug (MA-PD) organizations; Regional and Employer Group Health plans;  Demonstration projects;  Program of All-Inclusive Care for the Elderly (PACE) organizations;  Specialty plans; and Third party submitters contracted to submit data on behalf of risk adjustment organizations.  This is good for us risk adjustment coders to have a knowledge about this, but it is mostly used by the health plans.  https://www.csscoperations.com/internet/csscw3_files.nsf/F/CSSC2013_RA101ParticipantGuide_5CR_081513.pdf/$FILE/2013_RA101ParticipantGuide_5CR_081513.pdf

I was wondering what codes for transplant status actually risk adjust or have associated Risk Adjustment Factor (RAF), here's a list: Transplanted organs Z94.0 Kidney transplant status Z94.1 Heart transplant status Z94.2 Lung transplant status Z94.3 Heart and lungs transplant status Z94.4 Liver transplant status Other Z94.81 Bone marrow transplant status Z94.82 Intestine transplant status Z94.83 Pancreas transplant status Z94.84 Stem cells transplant status Kidney transplant is not included. These 'Z' codes communicate the status of a transplant. The only documentation needed is the provider's documentation of presence or history of there having been a transplant.  These codes belong in HCC 186 Major Organ Transplant or Replacement Status 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 ...

This is a link to the CMS site that has the list of HCC risk adjustment codes for this year and previous years.   https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors

On the CMS web page, there is a list of   Medicare Risk Adjustment Eligible CPT/HCPCS Codes Here is the link to download those:  https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/CPT-HCPCS 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.

  The Office of Inspector General's (OIG) work plan is posted at this link.  In the gray area, on the left, there is a  "What's New" box. At the bottom there is a link for "Recently completed and published reports". This shows you what they posted each month to date. I look for the ones that start with "Medicare Advantage Compliant Audits..." as those detail their audits of HCC codes for the MA organizations. Also on this page, under the title "Work Plan" there are links for 'Recently Added', "Active Work Plan Items', "Work Plan Archive'. Click on those for more information.  https://oig.hhs.gov/reports-and-publications/workplan/index.asp 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, reg...