Medicare adjusts payments to Medicare Advantage (MA) organizations for cost variations in providing health care to beneficiaries based on various risk factors, including health status. The goal of risk adjustment is to see that plans are properly reimbursed for the...
The Centers for Medicare and Medicaid (CMS) conduct Risk Adjustment Data Validation (RADV) audits to recover improper payments under Medicare Part C or Medicare Advantage (MA) plans. In risk adjustment or Hierarchical Condition Categories (HCCs), the focus is on...
HCC coding is important for health practices to increase their reimbursement opportunities. Outsourcing to a professional medical billing and coding company could ensure that the coding is accurate and claims are submitted in a timely manner. Making the Most of the...
The Centers for Medicare and Medicaid Services (CMS) (on July 31, 2014) has issued a final confirmation establishing October 1, 2015 as the new compliance date for transitioning to the ICD-10 medical diagnosis and billing codes. The date had been widely anticipated,...
Modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) is to be used to report an unrelated E/M (evaluation and management) service during the global period of a previous procedure. The expression “same...
