The Improper Payment Measurement or IPM provides statistical data on parts of the Medicare programs and reports overpayments and underpayments. The Medicare Part C beneficiary-level of payment errors from a given year is included and certainly is something to keep an eye on. The CMS IPM sample taken is extrapolated to determine the payment error to the risk adjustment...

The “coding” for HCCs (Hierarchical Condition Categories) is not for the faint of heart. As an outsider or non-coder, looking in, it would appear to be so simple, BUT, It is not simple or easy. No one should do HCC coding without extensive documentation and coding training as well as HCC code capture training – and preferably this person should be a certified coding...

Another Office of Inspector General (OIG) audit report which targets Medicare Advantage (MA) risk adjustment (RA) diagnoses has been released. This November audit report was focused on University of Pittsburg Medical Center (UPMC) Health Plan, Inc, and “high-risk” diagnosis from 2015-2016. This focused audit may sound familiar as we have seen several audit reports from...

CAM? Isn’t she some female American country music singer/songwriter? No – a CAM is a rotating or sliding piece in a mechanical linkage that has something to do with turning rotary motion into linear motion – at least that’s what the dictionary said. Besides, what would have female country music singer or a car engine part have to do with acupuncture? Well, they have...

According to a Pew Research Center analysis, retirement looms for 3.5 million retirees over the next year, including the most recent labor force data.1 Many organizations face this worrisome predicament, yet many health information management departments struggle with being proactive in their planning efforts. This week's blog post asked three healthcare industry leaders...

On November 2nd, 2021, the Centers for Medicare, and Medicaid Services (CMS) released their 2022 Physician Fee Schedule (PFS) final rule, which is 2,414 pages in length. Included in this policy ruling was also some other Medicare Part B issues. The PFS rule making is part of the Biden Administration strategy of better accessibility, quality, affordability, empowerment,...

Several important updates and additions were made to the ICD-10-CM Official Guidelines for Coding and Reporting for fiscal year 2022. Although key changes will be highlighted in this article, be sure to review the new and revised guidance in its entirety to ensure proper diagnosis coding and reporting. Additionally, visit our blogs about 9 Tips to Calm Coder Anxiety, ...

The purpose and intent of palliative care is often misunderstood. In 1990 the World Health Organization (WHO) recognized palliative care as a distinct medical specialty dedicated to relieving the suffering and improving the quality of life for patients with life-limiting illnesses, chronic disease, or serious injury. Despite its twenty-plus year history, many healthcare...

The Hospital Outpatient Prospective Payment System (OPPS) Final Rule for Fiscal Year 2022 has been released by the Centers for Medicare and Medicaid Services (CMS). Included in the 1394 page OPPS final rule announcement that came on 11/2/2021 was the 2022 payment policy for Ambulatory Surgery Centers (ASCs) which is available at: ...

Metrics represent values to measure an organization’s strategy. Leaders should understand that metrics cannot replace strategy. It can lead to behaviors that undermine the very strategy the metrics expect to measure, resulting in negative consequences for all. Remember the severe negative repercussions the banking giant, Wells Fargo experienced when it aggressively pushed...