On December 27, 2017, CMS published Part 1 of this year’s Medicare Advantage (MA) Advance Notice highlighting proposed changes in MA payments for 2019. CMS requires comments on this Part […]

Hierarchical Condition Categories (HCCs) have been the underlying risk adjustment for many Medicare programs for several years. But they didn’t attract wide interest until CMS began shifting more payment toward […]

Thanks for reading the Inside Angle blog in 2017! As 2018 approaches, revisit some of our most popular blogs of the year: 1. HCCs: A frequent factor in the value […]

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 […]

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 […]

In the past, I’ve written several blogs about the complexity of E/M coding and how to find your way through. The first step is to establish the place of service, […]

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 […]

I paraphrase, but this is essentially the question we hear from providers when we talk about ICD-10 coding accuracy.

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 […]

The results of a recent study from the University of Michigan’s Institute for Healthcare Policy and Innovation on payment rewards and penalties for Michigan hospitals participating in the Medicare Comprehensive Joint […]

In my previous blog, I addressed concerns about the new Sepsis 3 definitions.  In this blog (part 2), I will further flush out implications for specific quality metrics and also […]

So there are PPCs and HACs, PPRs and PPAs, PSIs and VBP just to name a few. But please don’t forget or underestimate the importance of HCCs. Why should you […]