In 1997, the Balanced Budget Act established a new part of Medicare called “Medicare + Choice” or Medicare Part C. Under this program, the federal government outsourced administration of Medicare […]

As a clinical documentation integrity (CDI) and coding professional, I’ve often heard the statement: If it’s not documented, it wasn’t done. I have used this statement educating physicians and nurses […]

I sat down with 3M Health Information Systems Global Chief Medical Officer Sandeep Wadhwa, MD, MBA, to discuss clinical and financial risk management, and risk stratification with Medicare Advantage plans. […]

I sat down with 3M Health Information Systems Global Chief Medical Officer Sandeep Wadhwa, MD, MBA, to discuss new benefits for Medicare Advantage enrollees and the importance of accurate and […]

As Medicare Advantage (MA) organizations report chronic disease conditions using ICD-10-CM encounter data to the Centers for Medicare and Medicaid Services (CMS) for use in the hierarchical condition category (HCC) […]

Audits of Hierarchical Condition Categories (HCCs) have been performed for years as a way for Part C vendors (Medicare Advantage Organizations) to identify and support patients with complex needs. Higher […]

In my previous blog, “Demystifying Medicare Risk Adjustment,” I introduced the model that the Centers for Medicare and Medicaid Services (CMS) uses to predict future Medicare Advantage health expenditures—the CMS-HCC […]

CMS has released the Advance Notice Parts I and II per the annual cycle of Medicare Advantage (MA) regulatory guidelines for the coming year. The Advance Notices provide the parameters […]

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 […]

Now that the masses have returned home from either the inauguration or protests in our nation’s capital, the Legislative and Executive branches have begun the daily scrum of governing. Given the polarized […]

Value-based insurance design (VBID) arrived in Washington, DC on the first day of 2017 when two of the largest federal government healthcare programs launched VBID demonstration programs.  The long-awaited Center […]

Happy New Year and thank you to all our readers! Before we officially start 2017, catch up on five of Inside Angle’s most read blogs of 2016: Overcoming skepticism about […]