As a physician, I am responsible for coding certain diagnoses that will trigger certain payment and risk adjustment. Risk adjustment scores are important in terms of quality measures and they […]

The ICD-10-PCS FY 2018 update was posted on the CMS website in the second half of May, and contains the changes to PCS that go into effect on October 1. […]

My colleagues and I were discussing the idea that modifiers have the most room for interpretation by professional fee coders, prompting a three-part blog series covering modifiers 24, 25 and […]

Value-based payment models are attracting attention for risk adjustment methodologies, especially HCC risk adjustment, which is used to calculate cost benchmarks for Medicare Advantage and other CMS payment models including […]

When coders say “coding is an art,” they don’t mean art—they don’t imagine themselves creating little medical record haiku. Describing coding as an art is a way of saying that […]

One premise of improving population health outcomes rests on the idea that we can be more pro-active in healthcare delivery. In addition to reacting to the “reason for visit” we […]

Political agreement across the aisle!  “What’s that?” you ask. Yes it is true that there is general agreement that healthcare payment in the U.S. has to transition from paying for […]

Shifting from volume-driven to value-based healthcare wouldn’t be so difficult if value meant just one thing. But every payer and value-based program defines value to suit its own purposes—on good […]

In this month’s blog we return to a recurring theme—the issues related to risk adjustment and performance measurement. More specifically, we think it is important to take a closer look […]

“Life goes on, having nowhere else to go.” – Diane Ackerman, The Moon by Whale Light These days, in the aftermath of the most discomfiting election season of my life, […]

So, this month I am taking a slight detour. Instead of continuing to dissect AHRQ version 6.0 changes, I would like to reflect on providers and quality. I promise to […]

Donna: Sue, do you know how many unspecified codes there are in ICD-10-CM? Sue: No, haven’t had time to count them!  Why do you ask? Donna: Well, as you know, […]