The Centers for Medicate and Medicaid (CMS) developed the Hierarchical Condition Categories (HCC) to calculate risk scores and adjust capitation payments made for beneficiaries enrolled in Medicare Advantage (MA) plans. The CMS Risk Adjustment Model includes nearly 80...
Coding experts in established medical coding companies are well-versed in the use of various modifiers to comply with industry guidelines. Simple two-character designators that indicate how the code for the procedure or service should be applied for the claim,...
For medical practices, insurance verification means knowing about their patients’ coverage in order to be able to bill for the services provided to them. For consumers, the current concern is how much they will have to pay as insurance premiums under Obamacare to keep...
A complex process, discharging patients from the hospital comes with many challenges, including liability risks. Nurse-led discharge, however, has gained wide acceptance in many developed countries as it has the potential to ensure that the patient receives the same...
Recent changes to both diagnostic and procedure codes as well as variability in requirements across private and public insurers pose many challenges for behavioral health medical billing: ICD-10-CM includes combination codes for some conditions and associated...
