The idea that, at some point in each of our lives, we may become acutely ill, eventually leading to the development of a chronic medical condition is a very real […]

Gestalt is defined as: “Something that is made of many parts and yet is somehow more than or different from the combination of its parts.”  Long ago, I remember attempting […]

Hierarchical Condition Categories (HCCs) have been used in the Centers for Medicare & Medicaid Services (CMS) risk adjustment payment model since 2004. That’s 17 years! More and more HIM professionals […]

As we all face the reality of day-to-day life during a pandemic, I consider myself in the lucky category. My husband and I may struggle as we manage two full-time […]

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 […]

After attending an AAPC presentation last year, I published a blog about HCC coding. Since then, I have continued to dive into the world of HCCs. To follow up on […]

Risk adjustment is a correction applied in hospital performance measurement to account for the contribution of population characteristics that are beyond the control of the hospital. The effects of these […]

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 […]

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 […]

While Congress is finding it difficult to reach consensus on how to improve health care in the United States, the one thing we all can agree on is that ever-rising […]

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 […]

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 […]