tag:blogger.com,1999:blog-49167838309424872702024-02-18T22:05:59.055-08:00MRA Alerts and UpdatesMRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.comBlogger1147125tag:blogger.com,1999:blog-4916783830942487270.post-29481412710793139922023-08-18T08:21:00.010-07:002023-08-18T08:29:55.534-07:00New Dates Added for V28 Risk Adjustment Webinars<p><br /></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQgihmwn_uPP4nGzFOEF_3lGNrV1N1Pv0KB-z2HyXTBfxy9hRNDZhBUv4eg22-7rttM0gtWwbm-gozzVK8xwr_N8rtmpZzG1neFgNacnSIjdHMTi2JBSxvlcYXqyjOZMR-Z0VMEa7g2OMdYI7KYQCYXJdt8H7_q6WCCcFlehR1WuCprYWkSJ3VTS-_uJLm/s2000/ERM%20V28%20Webinars.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2000" data-original-width="1545" height="529" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQgihmwn_uPP4nGzFOEF_3lGNrV1N1Pv0KB-z2HyXTBfxy9hRNDZhBUv4eg22-7rttM0gtWwbm-gozzVK8xwr_N8rtmpZzG1neFgNacnSIjdHMTi2JBSxvlcYXqyjOZMR-Z0VMEa7g2OMdYI7KYQCYXJdt8H7_q6WCCcFlehR1WuCprYWkSJ3VTS-_uJLm/w408-h529/ERM%20V28%20Webinars.png" width="408" /></a></div><br /><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 20px; white-space-collapse: preserve;"><br /></span><p></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif">NEW DATES ADDED - Prepare your TEAM for SUCCESS in 2024!!</span></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Are you looking for the BEST V28 Risk Adjustment Education? If so, GREAT NEWS – you found it! Register today for the ALL NEW V28 Webinars. Only $29.99 each – receive a 10% discount when you purchase 3 or more tickets for any event. All webinars are approved for 2 AAPC / AHIMA CEUs.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"> </p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><u>Introduction to V28 Risk Adjustment</u></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><u><br /></u></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">September 26, 2023, 1:00 PM to 3:00 PM</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><b>Registration Link:</b> <a href="https://events.eventzilla.net/e/introduction-to-v28-risk-adjustment-2138616726">https://events.eventzilla.net/e/introduction-to-v28-risk-adjustment-2138616726</a></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Agenda:</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Discuss the NEW V28 CMS Risk Adjustment Model.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Review Updated HCC Categories and Diagnoses.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Key Steps to Take Now for Success in 2024.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Approved for 2 CEUs from AAPC / AHIMA.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"> </p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><b><u><br /></u></b></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><u>Master HCC Coding for V28</u></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><u><br /></u></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">October 17, 2023, 1:00 PM to 3:00 PM</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><b>Registration Link:</b> <a href="https://events.eventzilla.net/e/master-hcc-coding-for-v28-2138616721">https://events.eventzilla.net/e/master-hcc-coding-for-v28-2138616721</a></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Agenda:</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Discuss the Rules of the Road for Risk Adjustment.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Review the Most Common HCCs per MedPac.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Master Documentation and Coding for HCCs in V28.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Approved for 2 CEUs from AAPC / AHIMA.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"> </p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><b><u><br /></u></b></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><u>V28 Risk Adjustment Optimization</u></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><u><br /></u></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">November 8, 2023, 1:00 PM to 3:00 PM</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><b>Registration Link:</b> <a href="https://events.eventzilla.net/e/v28-risk-adjustment-optimization-2138616723">https://events.eventzilla.net/e/v28-risk-adjustment-optimization-2138616723</a></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Agenda:</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Calculate Risk Scores and Payments for V28.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Identify Potential Areas of Impact in 2024.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Steps to Optimize Risk Adjustment Operations.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Approved for 2 CEUs from AAPC / AHIMA.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;">Visit <a href="http://www.ermconsultinginc.com">www.ermconsultinginc.com</a> to learn more.</p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br style="box-sizing: inherit;" /></p><p style="--artdeco-reset-typography_getfontsize: 1.6rem; --artdeco-reset-typography_getlineheight: 1.5; background-color: white; border: var(--artdeco-reset-base-border-zero); box-sizing: inherit; color: rgba(0, 0, 0, 0.9); counter-reset: list-1 0 list-2 0 list-3 0 list-4 0 list-5 0 list-6 0 list-7 0 list-8 0 list-9 0; cursor: text; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 20px; line-height: var(--artdeco-reset-typography_getLineHeight); margin: 0px; padding: 0px; vertical-align: var(--artdeco-reset-base-vertical-align-baseline); white-space-collapse: preserve;"><br /></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-33609165784841619252023-06-01T16:14:00.004-07:002023-06-01T16:19:01.921-07:00Upcoming V28 Risk Adjustment Webinars<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUfkf28iLkCHWkoAJgbQ14Y04XRcrUWmtPOE3CuTkFC5O_NcXoSwCL4WV_32JmHYyYpbLtRZz80AQ_T65CVtDpzXzvrO6hohbZ0R6-ftDMCg6UYGj4PD8uHmSoLJC-bZby2mtGbWI0YsVidsXawFw1BWQDyYYbUP5czZOHT9vzgo2zdeHdTHqJRJu1pg/s2000/V28%20Upcoming%20Events.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2000" data-original-width="1545" height="523" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUfkf28iLkCHWkoAJgbQ14Y04XRcrUWmtPOE3CuTkFC5O_NcXoSwCL4WV_32JmHYyYpbLtRZz80AQ_T65CVtDpzXzvrO6hohbZ0R6-ftDMCg6UYGj4PD8uHmSoLJC-bZby2mtGbWI0YsVidsXawFw1BWQDyYYbUP5czZOHT9vzgo2zdeHdTHqJRJu1pg/w404-h523/V28%20Upcoming%20Events.png" width="404" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p class="MsoNormal"><span style="font-size: 12pt;">Are you
looking for the BEST V28 Risk Adjustment Education? If so, GREAT NEWS – you
found it! Register today for the ALL NEW V28 Webinars. Tickets are $29.99 each
– Bring the team and receive a 10% discount when you purchase 3 or more tickets
for any event. All webinars are approved for 2 AAPC / AHIMA CEUs.</span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;">June 24,
2023, 2:00 PM to 4:00 PM – Introduction to V28 Risk Adjustment<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;">Registration
Link: </span><a href="https://events.eventzilla.net/e/introduction-to-v28-risk-adjustment-2138590700"><span style="font-size: 12pt; line-height: 107%;">https://events.eventzilla.net/e/introduction-to-v28-risk-adjustment-2138590700</span></a><span style="font-size: 12pt; line-height: 107%;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;">Agenda: <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"></p><span style="font-size: 12pt; line-height: 107%;"><ul style="text-align: left;"><li><span style="font-size: 12pt; line-height: 107%;">Discuss the NEW V28 CMS Risk
Adjustment Model.</span></li><li><span style="font-size: 12pt; line-height: 107%;">Review Updated HCC Categories and
Diagnoses.</span></li><li><span style="font-size: 12pt; line-height: 107%;">Key Steps to Take Now for Success in
2024.</span></li><li><span style="font-size: 12pt; line-height: 107%;">Approved for 2 CEUs from AAPC / AHIMA.</span></li></ul></span><!--[if !supportLists]--><p></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--></p>
<p class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;"> </span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;">July 22,
2023, 2:00 PM to 4:00 PM – Master HCC Coding for V28<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;">Registration
Link: </span><a href="https://events.eventzilla.net/e/master-hcc-coding-for-v28-2138590697"><span style="font-size: 12pt; line-height: 107%;">https://events.eventzilla.net/e/master-hcc-coding-for-v28-2138590697</span></a><span style="font-size: 12pt; line-height: 107%;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;">Agenda: <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="mso-list: l4 level1 lfo2; text-indent: -0.25in;"></p><span style="font-size: 12pt; line-height: 107%;"><ul style="text-align: left;"><li><span style="font-size: 12pt; line-height: 107%;">Discuss the Rules of the Road for
Risk Adjustment.</span></li><li><span style="font-size: 12pt; line-height: 107%;">Review the Most Common HCCs per
MedPac.</span></li><li><span style="font-size: 12pt; line-height: 107%;">Master Documentation and Coding for
HCCs in V28.</span></li><li><span style="font-size: 12pt; line-height: 107%;">Approved for 2 CEUs from AAPC /
AHIMA.</span></li></ul></span><!--[if !supportLists]--><p></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l4 level1 lfo2; text-indent: -0.25in;"><!--[if !supportLists]--></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l4 level1 lfo2; text-indent: -0.25in;"><!--[if !supportLists]--></p>
<p class="MsoListParagraphCxSpLast" style="mso-list: l4 level1 lfo2; text-indent: -0.25in;"><!--[if !supportLists]--></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;"> </span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;">August 26,
2023, 2:00 PM to 4:00 PM – V28 Risk Adjustment Optimization<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;">Registration
Link: </span><a href="https://events.eventzilla.net/e/v28-risk-adjustment-optimization-2138590696"><span style="font-size: 12pt; line-height: 107%;">https://events.eventzilla.net/e/v28-risk-adjustment-optimization-2138590696</span></a><span style="font-size: 12pt; line-height: 107%;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;">Agenda: <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo3; text-indent: -0.25in;"></p><span style="font-size: 12pt; line-height: 107%;"><ul style="text-align: left;"><li><span style="font-size: 12pt; line-height: 107%;">Calculate Risk Scores and Payments
for V28.</span></li><li><span style="font-size: 12pt; line-height: 107%;">Identify Potential Areas of Impact in
2024.</span></li><li><span style="font-size: 12pt; line-height: 107%;">Steps to Optimize Risk Adjustment
Operations.</span></li><li><span style="font-size: 12pt; line-height: 107%;">Approved for 2 CEUs from AAPC /
AHIMA.</span></li></ul></span><!--[if !supportLists]--><p></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo3; text-indent: -0.25in;"><!--[if !supportLists]--></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo3; text-indent: -0.25in;"><!--[if !supportLists]--></p>
<p class="MsoListParagraphCxSpLast" style="mso-list: l3 level1 lfo3; text-indent: -0.25in;"><!--[if !supportLists]--></p>
<span face=""Calibri",sans-serif" style="font-size: 12pt; line-height: 107%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br clear="all" style="break-before: page; mso-special-character: line-break; page-break-before: always;" />
</span>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%;"> </span></p>
<p class="MsoNormal"></p><p></p><div>Learn more www.ermconsultinginc.com</div><div><br /></div><div><br /></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-30457570790736566492022-04-16T09:23:00.010-07:002022-04-16T10:40:11.468-07:002022 HCC Risk Adjustment Tools for Physicians and Coders<p> </p><div class="cover__title" style="background-color: white; box-sizing: border-box; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; grid-row: 2 / auto; margin-bottom: 20px; text-align: center;"><div class="content" style="box-sizing: border-box; overflow-wrap: break-word; position: relative;"><h3 style="box-sizing: border-box; hyphens: auto; line-height: 1.05em; margin: 0px; opacity: 1; overflow-wrap: break-word; padding: 0px; position: relative; text-shadow: rgba(0, 0, 0, 0.2) 0px 1px 1px; transition: opacity 0.1s ease-in-out 0s;"><span style="font-family: georgia; font-size: large;">Is Your Team <span style="box-sizing: border-box;">Risk Ready?</span></span></h3></div></div><div class="cover__subtitle cover-title--long" style="background-color: white; box-sizing: border-box; grid-row: 3 / auto; margin-bottom: 40px; text-align: center;"><div class="content" style="box-sizing: border-box; overflow-wrap: break-word; position: relative;"><h3 style="box-sizing: border-box; color: #333333; font-family: "Proxima Nova"; font-size: 22px; font-weight: 400; hyphens: auto; line-height: 1.3em; margin: 0px; opacity: 1; overflow-wrap: break-word; padding: 0px; position: relative; text-shadow: rgba(0, 0, 0, 0.2) 0px 1px 1px; transition: opacity 0.1s ease-in-out 0s;">Arm Your Team For Combat This Risk <span style="box-sizing: border-box;">Adjustment Season!</span></h3><div><span style="box-sizing: border-box;"><h3 style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 30px; line-height: 1.3em; margin: 0px auto 16px; overflow-wrap: break-word; padding: 0px 8px; position: relative;">Prepare for Victory...</h3><div class="description" style="box-sizing: border-box; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px 8px; text-align: start;"><p style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">What will define those who claim victory and those who are defeated in the battle towards value based care? Will it be those organizations with the most money, power and seats at the table? Or will it be those who are nimble, flexible and open to change?</p><p style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">I believe it will be both. As victory will not be defined by the owners and head coaches but instead by how the players execute on the field. It will be the game time decisions that matter most. A quarterback who can read the defense and adjust accordingly will provide far greater value to the offense than the most athletic quarterback who misses the blitz every time.</p><p style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">Perhaps Napoleon said it best, "Battles are won by the power of the mind." For in a game of inches, the winners and losers will be defined by those who can execute in the moments that matter most. Prepare your team for victory with information at the point of care!</p><p style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">Learn more - <a href="https://erm.ecwid.com/" style="color: #d52a33; text-decoration-line: none;">https://erm.ecwid.com/</a></p><p style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">ORDER TODAY - THESE WILL GO FAST!!</p><p style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;"><br /></p><p style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;"></p><div class="separator" style="clear: both; text-align: left;"><a href="https://erm.ecwid.com/2022-CMS-HCC-Coding-Cards-12-Pack-p432478501" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="393" data-original-width="564" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOAq0NYu0ad2lrGrlJ-HDRAFcglqzV2ZmyyNQyuVEcIExyhz2keIeVJRf61WOuuw1RYzip2GTYyo3oM0r7ltR6SVLAh_DyDyH_FLqpsD97wFDRcqAzsoUHKjyDeiRMLP1alxTbp6BhgeAgN3hxZgsMxuXBqFJoVxFthsIE64dzo1XIadtnN6PNF8WPMw/s320/2020%20HCC%20Coding%20Cards.png" width="320" /></a></div><br /><p class="MsoNormal" style="background: white; line-height: 21.6pt; margin-bottom: 12.0pt; margin-left: 0in; margin-right: 0in; margin-top: 12.0pt; margin: 12pt 0in;"><b style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 16px;"><a href="https://erm.ecwid.com/2022-CMS-HCC-Coding-Cards-12-Pack-p432478501" style="color: #d52a33; text-decoration-line: none;" target="_blank">CMS-HCC Coding Cards</a></b></p><p style="line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;"><span face="Proxima Nova, -apple-system, BlinkMacSystemFont, Segoe UI, Roboto, Arial, sans-serif" style="color: #333333;"><a href="https://erm.ecwid.com/2022-CMS-HCC-Coding-Cards-12-Pack-p432478501">https://erm.ecwid.com/2022-CMS-HCC-Coding-Cards-12-Pack-p432478501</a></span></p><p style="line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">You will love these 5x7 HCC Coding Cards!</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Updated for 2022 - Version 24</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">This 14 pack is perfect your next risk adjustment project.</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">1.Diabetes:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">2.COPD:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">3.Heart Failure:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">4.Major Depressive Disorder:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">5.Malnutrition and Morbid Obesity:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">6.Complications with Internal Devices and Dependence:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips for Complications (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips for Dependency(side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">7. Infectious Disease:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 CDI / Coding Tips for HIV and Sepsis (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips for Liver Disease (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">8. Heart Failure:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">9. Chronic Kidney Disease:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">10. Seizures and Neurological Disorders:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">11. Diseases of the Digestive System:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 ICD-10 Coding Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">12. Primary and Secondary Neoplasms:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 ICD-10 Coding Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">13. Coagulation Defects:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">14. Disorders of Immunity</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">Post one to your bulletin board, stick one near the EHR or tape it to your workstation!</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><span style="background-color: transparent; border: 0px; box-shadow: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">HCC Coding Cards are made to last all year on thick 16 pt cardstock with a gloss finish.</span></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><span style="background-color: transparent; border: 0px; box-shadow: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"></span></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><span style="background-color: transparent; border: 0px; box-shadow: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Order for your team today!</span></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"><br /></strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"><span style="font-size: 18px; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"><a href="https://erm.ecwid.com/2022-CMS-HCC-Quick-Coder-p432456253" style="color: #d52a33; text-decoration-line: none;" target="_blank">CMS-HCC Quick Coders</a></span></strong></p><p><span style="background-color: transparent; border: 0px; box-shadow: none; float: none; font-size: 14px; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"><span face="Proxima Nova, -apple-system, BlinkMacSystemFont, Segoe UI, Roboto, Arial, sans-serif" style="color: #191919;"><a href="https://erm.ecwid.com/2022-CMS-HCC-Quick-Coder-p432456253">https://erm.ecwid.com/2022-CMS-HCC-Quick-Coder-p432456253</a></span></span></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">Completely updated for 2022 - Version 24</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">This 42 page guide contains everything you need to calculate a risk score in one place!</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">Includes of the most common HCC codes in the Medicare (CMS-HCC) model.</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">This guide was designed for providers, with codes sorted alphabetically rather than by code.</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;">Order one for the entire team today!</p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Includes:</strong></p><p style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"></strong></p><ul style="color: #191919; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 14px; line-height: 1.4; list-style-image: none; list-style-position: outside; margin: 0.5em 0px; padding: 0px 2.5em;"><li style="background-color: transparent; border: 0px; box-shadow: none; color: #333333; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">List of ICD-10 Guidelines</li><li style="background-color: transparent; border: 0px; box-shadow: none; color: #333333; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">270 ICD-10 Codes (Rx and HCCs)</li><li style="background-color: transparent; border: 0px; box-shadow: none; color: #333333; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Quality CPT II codes for MIPS / MACRA</li><li style="background-color: transparent; border: 0px; box-shadow: none; color: #333333; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">All CMS-HCC Risk Factors (includes demographic, disease and interaction)</li><li style="background-color: transparent; border: 0px; box-shadow: none; color: #333333; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Trump Chart</li></ul><div style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 13px;"><span style="color: #191919;"><span style="font-size: 14px;"><br /></span></span></div><div style="color: #333333; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 13px;"><span style="font-size: 16px;">Learn more / order here - </span><a href="https://erm.ecwid.com/" style="color: #d52a33; font-size: 16px; text-decoration-line: none;">https://erm.ecwid.com/</a></div></div></span></div></div></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-75266922309898110152022-04-01T16:54:00.004-07:002022-04-01T16:54:40.701-07:00Coding from the Problem List or Past Medical History<p><span face="Montserrat, sans-serif" style="background-color: white; font-family: arial; font-size: 14px;">Over the last few weeks I have received so many emails from coders with this question, “Is it okay for my team to code for conditions listed in the problem list or past medical history only? If not, why? Can you send me a guideline?”</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; overflow-wrap: break-word; padding: 0px; vertical-align: baseline;"><span style="font-family: arial;">The answer is NO – Your team should NEVER code for conditions that are listed in the problem list or past medical history only. Why? Per ICD-10 Coding Guidelines, codes should only be assigned for documented conditions that coexist at the time of the encounter/visit, and require or affect patient care, treatment, or management.</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; overflow-wrap: break-word; padding: 0px; vertical-align: baseline;"><span style="font-family: arial;">Coding professionals should not assign codes based solely on diagnoses noted in the history, problem list and/or a medication list. It is the provider’s responsibility to document that the chronic condition affected care and management of the patient for that encounter.</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; overflow-wrap: break-word; padding: 0px; vertical-align: baseline;"><span style="font-family: arial;">If the medical record is unclear or ambiguous regarding which condition(s) affected patient care and /or management of the patient, query the provider for clarification.</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; overflow-wrap: break-word; padding: 0px; vertical-align: baseline;"><span style="font-family: arial;">There is overwhelming evidence to support this practice. </span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; overflow-wrap: break-word; padding: 0px; vertical-align: baseline;"><span style="font-family: arial;">Download / view additional here https://erm365.org/coding-from-the-pl-or-pmh-only/</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/coding-from-the-pl-or-pmh-only/" imageanchor="1" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="571" data-original-width="452" height="566" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbZp3DhyH9hHyPD29FL9WJnDGWmwpwv_5RuYZfk6kds78BTVvSWPHWeNEySYgsSWIpsvDgCc5Adw2Sg2tecrrwJDERBXGS82cQN6CJiKrIcNQU95lifDLxI_MrTdlafLfRai8zqWG9SG9dO9p_eJqCSQ-EofFunYaQ2Ie2_zDIBMI7nOyfexdSi1WjiA/w447-h566/Coding%20from%20the%20PL%20or%20PMH%20only.png" width="447" /></a></div><br /><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; overflow-wrap: break-word; padding: 0px; vertical-align: baseline;"><br /></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-50704389076408851672022-01-11T10:22:00.004-08:002022-01-11T10:24:53.504-08:002022 CMS-HCC Risk Adjustment Tools<p> </p><div class="cover__title" style="background-color: white; box-sizing: border-box; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; grid-row: 2 / auto; margin-bottom: 20px; text-align: center;"><div class="content" style="box-sizing: border-box; overflow-wrap: break-word; position: relative;"><h3 style="box-sizing: border-box; hyphens: auto; line-height: 1.05em; margin: 0px; opacity: 1; overflow-wrap: break-word; padding: 0px; position: relative; text-shadow: rgba(0, 0, 0, 0.2) 0px 1px 1px; transition: opacity 0.1s ease-in-out 0s;"><span style="font-family: georgia; font-size: large;">Is Your Team <span style="box-sizing: border-box;">Risk Ready?</span></span></h3></div></div><div class="cover__subtitle cover-title--long" style="background-color: white; box-sizing: border-box; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; grid-row: 3 / auto; margin-bottom: 40px; text-align: center;"><div class="content" style="box-sizing: border-box; overflow-wrap: break-word; position: relative;"><h3 style="box-sizing: border-box; color: #333333; font-family: "Proxima Nova"; font-size: 22px; font-weight: 400; hyphens: auto; line-height: 1.3em; margin: 0px; opacity: 1; overflow-wrap: break-word; padding: 0px; position: relative; text-shadow: rgba(0, 0, 0, 0.2) 0px 1px 1px; transition: opacity 0.1s ease-in-out 0s;">Arm Your Team For Combat This Risk <span style="box-sizing: border-box;">Adjustment Season!</span></h3><div><span style="box-sizing: border-box;"><h3 style="color: #333333; font-size: 30px; line-height: 1.3em; margin: 0px auto 16px; overflow-wrap: break-word; padding: 0px 8px; position: relative;">Prepare for Victory...</h3><div class="description" style="box-sizing: border-box; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px 8px; text-align: start;"><p style="color: #333333; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">What will define those who claim victory and those who are defeated in the battle towards value based care? Will it be those organizations with the most money, power and seats at the table? Or will it be those who are nimble, flexible and open to change?</p><p style="color: #333333; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">I believe it will be both. As victory will not be defined by the owners and head coaches but instead by how the players execute on the field. It will be the game time decisions that matter most. A quarterback who can read the defense and adjust accordingly will provide far greater value to the offense than the most athletic quarterback who misses the blitz every time.</p><p style="color: #333333; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">Perhaps Napoleon said it best, "Battles are won by the power of the mind." For in a game of inches, the winners and losers will be defined by those who can execute in the moments that matter most. Prepare your team for victory with information at the point of care!</p><p style="color: #333333; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">Learn more - <a href="https://erm.ecwid.com/" style="color: #d52a33; text-decoration-line: none;">https://erm.ecwid.com/</a></p><p style="color: #333333; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">ORDER TODAY - THESE WILL GO FAST!!</p><div class="separator" style="clear: both; color: #333333; font-size: 16px; text-align: center;"><a href="https://erm.ecwid.com/2022-CMS-HCC-Coding-Cards-12-Pack-p432478501" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="393" data-original-width="564" height="223" src="https://blogger.googleusercontent.com/img/a/AVvXsEiYEmt_Ia9fbc1H0_V2Rney5QtYJFf17g0UpfzQpwbHVpVFleMY41_k1YZ760PjmXH86VtmIEENw9uQfaQgNavus9YDb5LXlKwpakYSbhXmko65x2GjBRBnzzDQ2ZMRsvAlpOl6NOfCJVfwB6fMNrWm-Uc-YRKi1PlB5npYLefsE65zLQHpkhP5YqeuDQ=s320" width="320" /></a></div><br /><p style="color: #333333; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;"><br /></p><p style="color: #333333; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;"><b><a href="https://erm.ecwid.com/2022-CMS-HCC-Coding-Cards-12-Pack-p432478501" target="_blank">CMS-HCC Coding Cards</a></b></p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">You will love these 5x7 HCC Coding Cards!</strong></p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Updated for 2022 - Version 24</strong></p><p style="color: #191919; font-size: 14px;"><br /></p><p style="color: #191919; font-size: 14px;"><br /></p><p style="color: #191919; font-size: 14px;">This 14 pack is perfect your next risk adjustment project.</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">1.Diabetes:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">2.COPD:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">3.Heart Failure:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">4.Major Depressive Disorder:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">5.Malnutrition and Morbid Obesity:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">6.Complications with Internal Devices and Dependence:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips for Complications (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips for Dependency(side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">7. Infectious Disease:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 CDI / Coding Tips for HIV and Sepsis (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips for Liver Disease (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">8. Heart Failure:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">9. Chronic Kidney Disease:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">10. Seizures and Neurological Disorders:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">11. Diseases of the Digestive System:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•ICD-10 ICD-10 Coding Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">12. Primary and Secondary Neoplasms:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•ICD-10 ICD-10 Coding Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">13. Coagulation Defects:</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">14. Disorders of Immunity</strong></p><p style="color: #191919; font-size: 14px;">•ICD-10 Coding Tips (side 1) includes RAF</p><p style="color: #191919; font-size: 14px;">•Clinical Documentation Tips (side 2) includes RAF</p><p style="color: #191919; font-size: 14px;">Post one to your bulletin board, stick one near the EHR or tape it to your workstation!</p><p style="color: #191919; font-size: 14px;"><span style="background-color: transparent; border: 0px; box-shadow: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">HCC Coding Cards are made to last all year on thick 16 pt cardstock with a gloss finish.</span></p><p style="color: #191919; font-size: 14px;"><span style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"></span></p><p style="color: #191919; font-size: 14px;"><span style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Order for your team today!</span></p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"><br /></strong></p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"><span style="font-size: 18px; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"><a href="https://erm.ecwid.com/2022-CMS-HCC-Quick-Coder-p432456253" target="_blank">CMS-HCC Quick Coders</a></span></strong></p><p style="color: #191919; font-size: 14px;">Completely updated for 2022 - Version 24</p><p style="color: #191919; font-size: 14px;">This 42 page guide contains everything you need to calculate a risk score in one place!</p><p style="color: #191919; font-size: 14px;">Includes of the most common HCC codes in the Medicare (CMS-HCC) model.</p><p style="color: #191919; font-size: 14px;">This guide was designed for providers, with codes sorted alphabetically rather than by code.</p><p style="color: #191919; font-size: 14px;">Order one for the entire team today!</p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Includes:</strong></p><p style="color: #191919; font-size: 14px;"><strong style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;"></strong></p><ul style="color: #191919; font-size: 14px; list-style-image: none; list-style-position: outside;"><li style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">List of ICD-10 Guidelines</li><li style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">270 ICD-10 Codes (Rx and HCCs)</li><li style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Quality CPT II codes for MIPS / MACRA</li><li style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">All CMS-HCC Risk Factors (includes demographic, disease and interaction)</li><li style="background-color: transparent; border: 0px; box-shadow: none; float: none; margin: 0px; outline: none; padding: 0px; position: static; z-index: auto;">Trump Chart</li></ul><div><span style="color: #191919;"><span style="font-size: 14px;"><br /></span></span></div><div><span style="color: #333333; font-size: 16px;">Learn more / order here - </span><a href="https://erm.ecwid.com/" style="color: #d52a33; font-size: 16px; text-decoration-line: none;">https://erm.ecwid.com/</a></div></div></span></div></div></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-63818925583507326422021-12-13T12:49:00.004-08:002021-12-13T12:52:06.043-08:00Key Litigation and Audits involving Risk Adjustment<p><span style="font-family: arial;">If you work in risk adjustment - you should be familiar with these cases. </span></p><span style="font-family: arial;"><div><span style="font-family: arial;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEixfr56drOgC5Jq-E2winwh_hd_FppReWIe3QUQ6p7wypQ1UGx0AFN8hsOWVgCgqBu35NJw0wNkdquCry56ogW10roeYnyfebSI1QIdk2Z9NwQaCSTpbrwfI_GqYaigYbV2y65d9ZYscQ4B6vgEYpQNqUkw11tKjX2nXsWnEfHopv4ia92KCrDlplV7Hg=s2000" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1333" data-original-width="2000" height="233" src="https://blogger.googleusercontent.com/img/a/AVvXsEixfr56drOgC5Jq-E2winwh_hd_FppReWIe3QUQ6p7wypQ1UGx0AFN8hsOWVgCgqBu35NJw0wNkdquCry56ogW10roeYnyfebSI1QIdk2Z9NwQaCSTpbrwfI_GqYaigYbV2y65d9ZYscQ4B6vgEYpQNqUkw11tKjX2nXsWnEfHopv4ia92KCrDlplV7Hg=w350-h233" width="350" /></a></div><br /><span style="font-family: arial;"><br /></span></div><br /></span><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On May
30, 2017, Freedom Health Inc., a Tampa, Florida-based provider of managed
care services, and its related corporate entities (collectively “Freedom
Health”), <a href="https://www.justice.gov/opa/pr/medicare-advantage-organization-and-former-chief-operating-officer-pay-325-million-settle" target="_blank">agreed to pay $31,695,593 to resolve allegations that they violated the False Claims Act</a> by engaging in illegal schemes to maximize their payment
from the government in connection with their Medicare Advantage plans, according to the
Justice Department.<o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On October
1, 2018, HealthCare Partners Holdings LLC, doing business as DaVita
Medical Holdings LLC (DaVita), <a href="https://www.justice.gov/opa/pr/medicare-advantage-provider-pay-270-million-settle-false-claims-act-liabilities" target="_blank">agreed to pay $270 million to resolve its False Claims Act liability for providing inaccurate information that caused Medicare Advantage Plans to receive inflated Medicare payments</a>, according to the Justice Department. DaVita is headquartered in El Segundo, California.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On April
12, 2019, Sutter Health LLC, a California-based healthcare services
provider, and several affiliated entities, Sutter East Bay Medical
Foundation, Sutter Pacific Medical Foundation, Sutter Gould Medical
Foundation, and Sutter Medical Foundation, <a href="https://www.justice.gov/opa/pr/medicare-advantage-provider-pay-30-million-settle-alleged-overpayment-medicare-advantage" target="_blank">agreed to pay $30 million to resolve allegations that the affiliated entities submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans</a>, which resulted in the plans and
providers being overpaid.<o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On
December 10, 2019, the OIG published a report, “Billions in Estimated
Medicare Advantage Payments From Chart Reviews Raise Concerns”. The OIG found
that diagnoses <a href="file:///C:/Users/kgiff/Documents/diagnoses%20that%20MAOs%20reported%20only%20on%20chart%20reviews-and%20not%20on%20any%20service%20records-resulted%20in%20an%20estimated%20$6.7%20billion%20in%20risk-adjusted%20payments%20for%202017.%20CMS%20based%20an%20estimated%20$2.7%20billion%20in%20risk%20adjusted%20payments%20on%20chart%20review%20diagnoses%20that%20MAOs%20did%20not%20link%20to%20a%20specific%20service%20provided%20to%20the%20beneficiary-much%20less%20a%20face%20to-face%20visit." target="_blank">MAOs reported only on chart reviews-and not on any service records-resulted in an estimated $6.7 billion in risk-adjusted payments for 2017.</a> <o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On
March 27, 2020, Geoffrey S. Berman, the United States Attorney for the
Southern District of New York, announced that the United States filed a
civil fraud lawsuit against Anthem, Inc. (“Anthem”), <a href="https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-files-civil-fraud-suit-against-anthem-inc-falsely-certifying" target="_blank">alleging that Anthem falsely certified the accuracy of the diagnosis data it submitted to the Centers for Medicare and Medicaid Services (“CMS”) for risk-adjustment purposes under Medicare Part C and knowingly failed to delete inaccurate diagnosis codes. </a><span style="mso-spacerun: yes;"> </span>As a result of these acts, Anthem caused
CMS to calculate the risk-adjustment payments to Anthem based on
inaccurate, and inflated, diagnosis information, which enabled Anthem to
obtain millions of dollars in Medicare funds to which it was not entitled.<o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On
June 23, 2020, Aveta Inc. and a whistleblower settled a False Claims Act
suit alleging that its <a href="https://www.law360.com/articles/1285784" target="_blank">Medicare Advantage plans collected $1 billion in government overpayments</a>,
ending a dispute that served as an early test for litigation involving risk
adjustment fraud. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On August
5, 2020, a whistleblower case filed by the Department of Justice was
unsealed. The complaint accuses Cigna of fraudulently overbilling for its
Medicare Advantage plans. A former service provider for Cigna’s Medicare
Advantage subsidiary alleged that the company sent providers to patients’
homes to conduct a health assessment, which was then improperly submitted
to the Centers for Medicare and Medicaid Services for risk adjustment. <a href="https://www.healthcaredive.com/news/doj-cigna-medicare-advantage-fraud-lawsuit/583023/" target="_blank">Allegations include claims the company submitted unsupported diagnoses that resulted in “billions” in overpayments.</a> Litigation is ongoing - <span style="line-height: 107%;">7:17-cv-07515-KMK-JCM United
States of America, EX REL. Robert A. Cutler v. Cigna Corp. et al.</span><o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On
November 16, 2020, Kaiser Foundation Health Plan of Washington, formerly
known as Group Health Cooperative (GHC), <a href="https://www.justice.gov/usao-wdny/pr/medicare-advantage-provider-pay-63-million-settle-false-claims-act-allegations" target="_blank">agreed
to pay $6,375,000 to resolve allegations that it
submitted invalid diagnoses to Medicare for Medicare Advantage
beneficiaries</a> and received inflated payments from Medicare as a
result, the Justice Department announced.<o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On April
19, 2021, the OIG published an audit of diagnosis codes that Humana submitted
to CMS for one contract. <a href="https://oig.hhs.gov/oas/reports/region7/71601165.asp" target="_blank">The OIG recommended that Humana refund to the Federal Government the $197.7 million of net overpayments</a> and enhance its policies and procedures to
prevent, detect, and correct noncompliance with Federal requirements for
diagnosis codes that are used to calculate risk-adjusted payments.<o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On
July 30, 2021, the <a href="https://www.justice.gov/opa/pr/government-intervenes-false-claims-act-lawsuits-against-kaiser-permanente-affiliates" target="_blank">United States intervened in
six separate False Claims Act (FCA) whistleblower cases alleging Medicare
Advantage fraud</a>. The lawsuits allege that Kaiser Permanente and
several of its medical groups knowingly submitted inaccurate diagnosis
codes for their Medicare Advantage Plan enrollees. The suit alleges
that Kaiser did this to receive higher reimbursements from the government. Litigation is ongoing in all cases. <o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in; text-align: left;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;"><span style="font-family: arial;">On
August 30, 2021, the government announced a <a href="https://www.justice.gov/opa/pr/sutter-health-and-affiliates-pay-90-million-settle-false-claims-act-allegations-mischarging" target="_blank">$90 million False Claims Act settlement</a> with
California-based health care services provider Sutter Health. The
settlement resolves allegations that Sutter knowingly submitted inaccurate
diagnosis codes for beneficiaries enrolled in Medicare Advantage
Plans. This inaccurate information led to inflated payments to
Medicare Advantage Plans and Sutter Health.<o:p></o:p></span></li></ul><span style="font-family: arial;"><br /></span><ul style="margin-top: 0in; text-align: left;" type="disc">
<li><span style="font-family: arial;">On September 14, 2021, <a href="https://www.justice.gov/opa/pr/united-states-intervenes-and-files-complaint-false-claims-act-suit-against-health-insurer?link_id=16&can_id=5781e25cacd729b2415e968fdb698b33&source=email-colorado-attorney-general-calls-for-state-false-claims-act&email_referrer=email_1293741___from_1709760&email_subject=sec-whistleblower-program-hits-1-billion-milestone" target="_blank">DOJ filed a Medicare Advantage fraud lawsuit</a> against
Independent Health and its former CEO. Independent Health offers two
Medicare Advantage Plans in New York State. The United States has also
sued Independent Health’s subsidiary, DxID. DxID provided retrospective
chart review and addenda services to Independent Health and other MA Plans. The
case is captioned United States ex rel. Ross v. Independent Health Association
et al., No. 12-CV-0299(S)</span></li></ul><div><br /></div><div><span style="font-family: arial;"><br /></span></div><div><br /></div>
<p class="MsoListParagraph" style="mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;"><o:p></o:p></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-52856683428936834452021-12-13T12:30:00.011-08:002021-12-13T13:00:01.773-08:00The BEST Risk Adjustment Education <p> </p><div class="separator" style="clear: both; text-align: center;"><a href="http://www.erm365.org/events" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="293" data-original-width="542" height="264" src="https://blogger.googleusercontent.com/img/a/AVvXsEinz8XjdMNNSlxdQyd140twLfIiV2UrA5i2MFPfQI4jSe1wP9taPj9f8Xxa3DNdjEyXL4D3C5v7d1UfBD5V95oFTkXPVbRE-uEyNhWGvJE_wMH1lKMnvc_UZvN_DE2rdS_Kou_lupvK99_bcQZDltNfU3m1s0psOyvy36FM2hpBPrwFqYMscVHmo7mIbg=w490-h264" width="490" /></a></div><br /><p></p><h3 style="text-align: left;"><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white;">Are you looking for the best education available in risk adjustment, value-based payments and/or CDI? Good News - You have found it!</span></h3><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white;">Join us for a day of risk adjustment and get the BEST risk adjustment education available for $49. </span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: inherit;" /><div><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white;">Do you need CMEs, CEs or CEUs? We have that too!</span></div><div><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white;">All Workshops are approved by the American Medical Association, American Academy of Family Practice, Commission for Case Manager Certification, and the American Academy of Professional Coders.</span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white;">Register your team (3 or more) today to save 10% on any 2022 Workshops!</span><div><br /></div><div><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white;">Upcoming dates: </span></div><div><ul style="text-align: left;"><li><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white;">Saturday, January 22, 2022 </span><span color="rgba(0, 0, 0, 0.901960784313726)" face="-apple-system, system-ui, BlinkMacSystemFont, Segoe UI, Roboto, Helvetica Neue, Fira Sans, Ubuntu, Oxygen, Oxygen Sans, Cantarell, Droid Sans, Apple Color Emoji, Segoe UI Emoji, Segoe UI Emoji, Segoe UI Symbol, Lucida Grande, Helvetica, Arial, sans-serif"><span><a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-coding-for-vbp--online-2138830654">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-coding-for-vbp--online-2138830654</a></span></span></li><li><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white;">Friday, February 25. 2022 </span><span color="rgba(0, 0, 0, 0.901960784313726)" face="-apple-system, system-ui, BlinkMacSystemFont, Segoe UI, Roboto, Helvetica Neue, Fira Sans, Ubuntu, Oxygen, Oxygen Sans, Cantarell, Droid Sans, Apple Color Emoji, Segoe UI Emoji, Segoe UI Emoji, Segoe UI Symbol, Lucida Grande, Helvetica, Arial, sans-serif"><span><a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-coding-for-vbp--online-2138830649">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-coding-for-vbp--online-2138830649</a></span></span></li><li><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white;">Friday, March 25, 2022 </span><span color="rgba(0, 0, 0, 0.901960784313726)" face="-apple-system, system-ui, BlinkMacSystemFont, Segoe UI, Roboto, Helvetica Neue, Fira Sans, Ubuntu, Oxygen, Oxygen Sans, Cantarell, Droid Sans, Apple Color Emoji, Segoe UI Emoji, Segoe UI Emoji, Segoe UI Symbol, Lucida Grande, Helvetica, Arial, sans-serif"><span><a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-coding-for-vbp--online-2138830648">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-coding-for-vbp--online-2138830648</a></span></span></li></ul></div><div><br /></div></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://www.erm365.org/events" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="363" data-original-width="535" height="368" src="https://blogger.googleusercontent.com/img/a/AVvXsEhvtMI392a0FsP6hrmdtXHYfzXTZEL6sne2_YxTA4B_5Z3pAcE9ExLKvq90DU4EYi3-gK_dupmtsYNUrBC_OwfX9D7e0OrrtE8Fv8M8mPk6fPKmvZP8ylHAl4xDAc5azGWyXMXCxNC0J8MmxuInweLv1QxneI4bCmUvYfy8VloDLJYbw3OwRo1Nm3ob5w=w542-h368" width="542" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div><br /></div><div><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 14px;">Learn more / Download the agenda here - </span><a data-attribute-index="0" href="http://www.erm365.org/events" style="background-color: white; border: var(--artdeco-reset-link-border-zero); box-sizing: inherit; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 14px; font-weight: var(--font-weight-bold); line-height: inherit; margin: var(--artdeco-reset-base-margin-zero); padding: var(--artdeco-reset-base-padding-zero); position: relative; text-decoration: var(--artdeco-reset-link-text-decoration-none); touch-action: manipulation; vertical-align: var(--artdeco-reset-base-vertical-align-baseline);">www.erm365.org/events</a></div><div><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 14px; line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 14px;">Workshops typically sell out 2 weeks or more before the event. </span></div><div><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 14px;">Don't wait - register your team today!!</span></div><div><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 14px;"><br /></span></div><div><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 14px;"><br /></span></div><div><br /></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-30665261548658603922021-06-02T12:40:00.007-07:002021-06-02T12:42:23.515-07:00The BEST Risk Adjustment Workshop Available<p><span style="font-family: arial;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial;"><a href="http://www.erm365.org/events" imageanchor="1" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="1106" data-original-width="850" height="494" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZTvv_whCowijPWFqa5N4l2J-oWKc1tijTd-BdP7aeLhVPyDP0BIkILuXQEKvAaa0ol0sATKypwaIriO_4q4_o-SWEMp_CG6sOc914zwcIgRWGuTWcApYLBqXl_iLOgmEg9qM1vMzg7M9t/w379-h494/ARM+Flyer+Updated+4.30.2021.png" width="379" /></a></span></div><span style="font-family: arial;"><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></span><p></p><p><b style="color: #333333; font-family: arial; font-size: 13px;">Are you looking for the best risk adjustment education available? If so, GREAT NEWS, you found it! Join us virtually for a day of risk adjustment, CDI and HCC coding! NEW DATES added below:</b></p><p style="background-color: #fefdfa; color: #333333; font-size: 13px;"><span style="font-family: arial;"><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">June 25, 2021 – Register for tickets here <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808989" style="color: #d52a33; text-decoration-line: none;">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808989</a></span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">July 30, 2021 – Register for tickets here <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808991" style="color: #d52a33; text-decoration-line: none;">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808991</a></span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">August 27, 2021 – Register for tickets here <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808990" style="color: #d52a33; text-decoration-line: none;">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808990</a></span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">September 24, 2021 – Register for tickets here <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808986" style="color: #d52a33; text-decoration-line: none;">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808986</a></span></span></p><p style="background-color: #fefdfa; color: #333333; font-size: 13px;"><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;"><span style="font-family: arial;"><br /></span></span></p><p style="background-color: #fefdfa; color: #333333; font-size: 13px;"><span style="font-family: arial;"><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">APROVED by: AMA, AAFP, AAPC and CCMC - Earn 7.0 CEUs, 6 CMEs and/or 5.5 CEs. - $49 per Attendee</span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;"><br /></span></span></p><p style="background-color: #fefdfa; color: #333333; font-size: 13px;"><span style="font-family: arial;"><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">Register your team today and save 10% with group discounts!</span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;"><br /></span></span></p><p style="background-color: #fefdfa; color: #333333; font-size: 13px;"><span style="font-family: arial;"><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">LEARN MORE at </span><a data-attribute-index="10" href="http://www.erm365.org/events" style="background: rgb(255, 255, 255); border: 0px; box-sizing: inherit; color: #d52a33; font-weight: var(--font-weight-bold); line-height: inherit; margin: 0px; padding: 0px; position: relative; text-decoration-line: none; touch-action: manipulation; vertical-align: baseline;">www.ERM365.org/events</a><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-size: 14px; line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 14px;"> </span></span></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-40559261573112050252021-04-30T16:36:00.009-07:002021-05-01T07:39:39.234-07:00Advanced Risk Management and HCC Workshop<div class="separator" style="clear: both; text-align: center;"><a href="http://erm365.org/events/" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="899" data-original-width="678" height="524" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLNG8A7nnI3MaBGh0h_LUrVUO-XR_i_k_dsAfHznSY3i0jvm27hjbdfvY1Bk1YAc-MPw-6DJ99F2xAKpjzc1eTGDKyMJfYq38VbQbTYUgzz9ruckVtjSKSrP45QxOGFKI9bn1SjH3LQmnQ/w395-h524/ARM+2021.png" width="395" /></a></div><br /><p><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;"><span style="font-family: arial;">Are you looking for the best risk adjustment education available? If so, GREAT NEWS, you found it! Join us virtually for a day of risk adjustment, CDI and HCC coding! NEW DATES added below:</span></span></p><p><span style="font-family: arial;"><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">June 25, 2021 – Register for tickets here <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808989">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808989</a></span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">July 30, 2021 – Register for tickets here <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808991">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808991</a></span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">August 27, 2021 – Register for tickets here <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808990">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808990</a></span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">September 24, 2021 – Register for tickets here <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808986">https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808986</a></span></span></p><p><span style="font-family: arial;"><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;"><br /></span></span></p><p><span style="font-family: arial;"><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">APROVED by: AMA, AAFP, AAPC and CCMC - Earn 7.0 CEUs, 6 CMEs and/or 5.5 CEs. - $49 per Attendee</span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;"><br /></span></span></p><p><span style="font-family: arial;"><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">Register your team today and save 10% with group discounts!</span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;"><br /></span></span></p><p><span style="font-family: arial;"><span color="rgba(0, 0, 0, 0.9)" style="background-color: white;">LEARN MORE at </span><a data-attribute-index="10" href="http://www.erm365.org/events" style="background: rgb(255, 255, 255); border: 0px; box-sizing: inherit; font-weight: var(--font-weight-bold); line-height: inherit; margin: 0px; padding: 0px; position: relative; text-decoration-line: none; touch-action: manipulation; vertical-align: baseline;">www.ERM365.org/events</a></span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 14px; line-height: inherit;" /><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 14px;"> </span><br style="background-color: white; box-sizing: inherit; color: rgba(0, 0, 0, 0.9); font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif; font-size: 14px; line-height: inherit;" /></p><p><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 14px;"><br /></span></p><p><span color="rgba(0, 0, 0, 0.9)" face="-apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", "Fira Sans", Ubuntu, Oxygen, "Oxygen Sans", Cantarell, "Droid Sans", "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Lucida Grande", Helvetica, Arial, sans-serif" style="background-color: white; font-size: 14px;"><br /></span></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com6tag:blogger.com,1999:blog-4916783830942487270.post-71997255238491970722021-04-21T04:20:00.004-07:002021-04-21T04:20:43.345-07:00Medicare Advantage Compliance Audit of Diagnosis Codes That Humana Submitted to CMS<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://oig.hhs.gov/oas/reports/region7/71601165.pdf" imageanchor="1" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="808" data-original-width="669" height="485" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRr4xl9yzdWAuHq8_PDqJg5QsL_nPuDAZHqLY66-UZxKh_JvDSzC6NxWWQueqcxGCs39bhQr3zRlL6G5MrkCnkhMob8AQmocUbVTHbW3tZPQjBxAzXcXKqIzj33UXKhr6nidYEJQgUNe-k/w402-h485/OIG+Humana+Report.png" width="402" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p><br /></p><p></p><p class="report-metadata" style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 200ch;">04-19-2021 | A-07-16-01165 | <a href="https://oig.hhs.gov/oas/reports/region7/71601165.pdf" style="background-color: transparent; box-sizing: inherit; color: #0071bc;">Complete Report</a> | <a href="https://oig.hhs.gov/oas/reports/region7/71601165RIB.pdf" style="background-color: transparent; box-sizing: inherit; color: #0071bc;">Report in Brief</a></p><h3 style="background-color: white; box-sizing: inherit; clear: both; color: #212121; font-family: Merriweather, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 2rem; line-height: 1.3; margin-bottom: 0.5em; margin-top: 1.5em;">Why OIG Did This Audit</h3><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;">Under the Medicare Advantage (MA) program, the Centers for Medicare & Medicaid Services (CMS) makes monthly payments to MA organizations according to a system of risk adjustment that depends on the health status of each enrollee. Accordingly, MA organizations are paid more for providing benefits to enrollees with diagnoses associated with more intensive use of health care resources than to healthier enrollees who would be expected to require fewer health care resources.</p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;">To determine the health status of enrollees, CMS relies on MA organizations to collect diagnosis codes from their providers and submit these codes to CMS. CMS then maps certain diagnosis codes, on the basis of similar clinical characteristics and severity and cost implications, into Hierarchical Condition Categories (HCCs). CMS makes higher payments for enrollees who receive diagnoses that map to HCCs.</p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;">For this audit, we reviewed one of the contracts that Humana, Inc., has with CMS with respect to the diagnosis codes that Humana submitted to CMS. Our objective was to determine whether Humana submitted diagnosis codes to CMS for use in the risk adjustment program in accordance with Federal requirements.</p><h3 style="background-color: white; box-sizing: inherit; clear: both; color: #212121; font-family: Merriweather, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 2rem; line-height: 1.3; margin-bottom: 0.5em; margin-top: 1.5em;">How OIG Did This Audit</h3><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;">We selected a sample of 200 enrollees with at least 1 diagnosis code that mapped to an HCC for 2015. Humana provided medical records as support for 1,525 HCCs associated with the 200 enrollees. We used an independent medical review contractor to determine whether the diagnosis codes complied with Federal requirements.</p><h3 style="background-color: white; box-sizing: inherit; clear: both; color: #212121; font-family: Merriweather, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 2rem; line-height: 1.3; margin-bottom: 0.5em; margin-top: 1.5em;">What OIG Found</h3><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;">Humana did not submit some diagnosis codes to CMS for use in the risk adjustment program in accordance with Federal requirements. First, although most of the diagnosis codes that Humana submitted were supported in the medical records and therefore validated 1,322 of the 1,525 sampled enrollees' HCCs, the remaining 203 HCCs were not validated and resulted in overpayments. These 203 unvalidated HCCs included 20 HCCs for which we identified 22 other, replacement HCCs for more and less severe manifestations of the diseases. Second, there were an additional 15 HCCs for which the medical records supported diagnosis codes that Humana should have submitted to CMS but did not.</p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;">Thus, the risk scores for the 200 sampled enrollees should not have been based on the 1,525 HCCs. Rather, the risk scores should have been based on 1,359 HCCs (1,322 validated HCCs + 22 other HCCs + 15 additional HCCs). As a result, we estimated that Humana received at least $197.7 million in net overpayments for 2015. These errors occurred because Humana's policies and procedures to prevent, detect, and correct noncompliance with CMS's program requirements, as mandated by Federal regulations, were not always effective.</p><h3 style="background-color: white; box-sizing: inherit; clear: both; color: #212121; font-family: Merriweather, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 2rem; line-height: 1.3; margin-bottom: 0.5em; margin-top: 1.5em;">What OIG Recommends and Humana's Comments</h3><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;">We recommend that Humana refund to the Federal Government the $197.7 million of net overpayments and enhance its policies and procedures to prevent, detect, and correct noncompliance with Federal requirements for diagnosis codes that are used to calculate risk-adjusted payments.</p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;">Humana disagreed with our findings and with both of our recommendations. Humana provided additional medical record documentation which, Humana said, substantiated specific HCCs. Humana also questioned our audit and statistical sampling methodologies and said that our report reflected misunderstandings of legal and regulatory requirements underlying the MA program. After reviewing Humana's comments and the additional information that it provided, we revised the number of unvalidated HCCs for this final report. We followed a reasonable audit methodology, properly executed our sampling methodology, and correctly applied applicable Federal requirements underlying the MA program. We revised the amount in our first recommendation from $263.1 million (in our draft report) to $197.7 million but made no change to our second recommendation.</p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;"><a href="https://oig.hhs.gov/oas/reports/region7/71601165.pdf" target="_blank">Complete Report</a> available here. </p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;"><br /></p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;"><br /></p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: "Source Sans Pro", "Helvetica Neue", Helvetica, Roboto, Arial, sans-serif; font-size: 17px; line-height: 1.5; margin-bottom: 1em; margin-top: 1em; max-width: 100ch;"><br /></p><p> </p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1tag:blogger.com,1999:blog-4916783830942487270.post-36294917570837414482021-04-02T07:50:00.000-07:002021-04-02T07:50:11.267-07:00Medicare Risk Adjustment Operations<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/courses/medicare-risk-adjustment-operations/" imageanchor="1" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="627" data-original-width="932" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_hhzUj_OHB_tJDRq0reh4FL_je8DbniT8GKi20-Aq4n9A_5u1HB0hs69IOIeMR-qmo3YcJD8qFAT2qrH3goUqCMfFu4-1stINeQ7lWIXZks03C7yPbtz4jEzKuzitHyVBBTHI_WyamDpd/w432-h290/Medicare+Risk+Adjustment+Operations.png" width="432" /></a></div><br /> <p></p><p><strong><a href="https://erm365.org/courses/medicare-risk-adjustment-operations/" target="_blank">Medicare Risk Adjustment Operations</a></strong></p><p><strong>On-Demand Course Overview:</strong></p><p>Medicare Advantage (MA) is one of the fastest-growing and most complex health plan lines of business representing significant growth opportunities for payers. Launching and/or managing a successful MA market requires careful, strategic planning to meet requirements, ensure compliance, and maximize the program benefits for your organization.</p><p>Success in this market will depend on success in each of the following essential areas:</p><ul><li>Value-based contracting</li><li>Clinical documentation and coding</li><li>Delivering high quality care</li><li>Managing utilization</li></ul><p>This course will touch on all four essential areas of MRA Operations.</p><p><strong>APPROVED by the AAPC for 5 CEUs - $9.99 until 4/9/2021 and then $19.99</strong></p><p>Register here <a href="https://erm365.org/courses/medicare-risk-adjustment-operations/">https://erm365.org/courses/medicare-risk-adjustment-operations/</a></p><div><br /></div><div>Learn more about <a href="http://www.erm365.org" target="_blank">ERM365</a></div><div><br /></div><div><br /></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com3tag:blogger.com,1999:blog-4916783830942487270.post-71027832798766114942021-03-20T16:01:00.003-07:002021-03-20T16:09:50.030-07:00Let's Talk About Risk<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/courses/lets-talk-about-risk-on-demand/" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="777" data-original-width="1384" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiP56rdYpE2WvLeMH4I94v0byJnal8XM3kceZg3QnzOGT0mqEYuP6ei2CmiJVPTjdWky6YOi0yQujmby5rb2XenkoUkkq1FqyuN17mlGJMtvsdqq4J_depikYrHOYdwowmllJoW-2ZTuiiF/w515-h290/Let%2527s+Talk+About+Risk+On+Demand.png" width="515" /></a></div><br /> <span face="Montserrat, sans-serif" style="border: 0px; box-sizing: border-box; font-size: 14px; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Approved by the AAPC for 2 CEUs</span><span face="Montserrat, sans-serif" style="border: 0px; box-sizing: border-box; font-size: 14px; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> - $5.99 </span><span face="Montserrat, sans-serif" style="border: 0px; box-sizing: border-box; font-size: 14px; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">(on SALE until 3/25/2021 - then $14.99)</span><p></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Review the Agenda:</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: underline; vertical-align: baseline;">Section 1 – Risk Adjustment Basics</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">This section will cover basic concepts and terminology in the CMS-HCC Model of Risk Adjustment.</p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What is an HCC?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Why are HCCs important?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">How is a risk score calculated?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What is the value of an HCC?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are the most common HCCs?</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: underline; vertical-align: baseline;">Section 2 – Rules of the Road</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">This section will cover ICD-10 Guidelines and other “rules” related to clinical documentation and coding within the CMS-HCC Model of Risk Adjustment.</p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">When should a diagnosis be coded?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">How often can a diagnosis be coded</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What clinical documentation is needed to support the diagnosis?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Is it okay to code for resolved conditions?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Would it be acceptable to code a diagnosis documented as “suspected” in an outpatient setting such as a provider’s office?</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: underline; vertical-align: baseline;">Section 3 – HCC Coding</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">This section will review the most common HCC’s for Medicare enrollees based on MedPAC data.</p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are the twenty most common HCC categories for Medicare enrollees?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are the most common ICD-10 codes included in each category?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">How can clinical documentation impact code selection?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are common errors leading to inaccurate risk scores?</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: underline; vertical-align: baseline;">Section 4 – Tips for Success</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">This section will cover simple tips that will make a big impact. At the end of this lesson you will be able to work smarter not harder.</p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What should be included in the problem list?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Why does clinical documentation need to clarify active vs. history of?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What small changes can you start making today that will have a big impact on the accuracy of your risk scores?</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"> </p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="box-sizing: border-box; font-weight: 700;">Who Should Attend? </span></p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Coders, Billers, and Auditors</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Physicians, NPs and PAs</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Medical Assistants and Front Office</li></ul><div style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </div><div style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="box-sizing: border-box; font-weight: 700;">Price:</span> $5.99 SALE until 3/25/2021, then $14.99 </div><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Purchase includes a copy of the presentation and other resources. </li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">180 days of access to course and materials. </li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"> </p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">On Demand Course Instructions for CEUs:</span></p><ol style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Login or Register for a FREE account with <a href="http://www.erm365.org" target="_blank">ERM365</a>.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Purchase the<a href="https://erm365.org/courses/lets-talk-about-risk-on-demand/" target="_blank"> course</a>.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Click on “My Dashboard” and then “My Courses” to access.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Download the handouts and other resources.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Watch the video.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Pass the post quiz.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Download CEU Certificate. </li></ol><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1tag:blogger.com,1999:blog-4916783830942487270.post-10220043939264482092021-03-19T13:00:00.009-07:002021-03-20T16:41:51.217-07:00Master E/M Coding 2021<div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/courses/master-e-m-coding-for-2021/" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="684" data-original-width="1230" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifq715bv-eYCKT8rCk0dgTXD6VDHVVE7_YODIY_u6y6VYom1ux-G-aG-oJSgnZzFEIS52M2xlMXDW6CenCsJeu9UxUaAzZ0f8iSZypMWOCBRJ0T0g6vIkoaKSsvh0gMZ6Dr6_XkesVTLsK/w525-h292/Master+E.M+Coding+for+2021.png" width="525" /></a></div><br /><p><br /></p><h4 class="elementor-heading-title elementor-size-default" style="background-color: white; border: 0px; box-sizing: border-box; clear: both; color: #2026a9; font-family: Montserrat, sans-serif; font-size: 1.42857rem; font-weight: 400; line-height: 1.5; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">E/M Changes Took Effect January 2021</h4><div><span style="background-color: white; font-size: 14px;"><span style="font-family: arial;"><br /></span></span></div><div><span style="background-color: white; font-size: 14px;"><span style="font-family: arial;">As of January 1, 2021, physicians will select an E/M code based on total time spent on the date of the encounter or medical decision making (MDM)—whichever is most financially advantageous. </span></span></div><div><span style="background-color: white; font-size: 14px;"><span style="font-family: arial;"><br /></span></span></div><div><span face="Montserrat, sans-serif" style="background-color: white; font-size: 14px;"><br /></span></div><div><h4 class="elementor-heading-title elementor-size-default" style="background-color: white; border: 0px; box-sizing: border-box; clear: both; color: #2026a9; font-family: Montserrat, sans-serif; font-size: 1.42857rem; font-weight: 400; line-height: 1.5; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What was the Goal of Revising the E/M Coding for Office Visits?</h4></div><div><div><ul style="text-align: left;"><li><span style="font-family: arial;">To decrease the administrative burden of documentation and coding</span></li></ul><ul style="text-align: left;"><li><span style="font-family: arial;">To decrease the need for audits, through the addition and expansion of key definitions and guidelines</span></li></ul><ul style="text-align: left;"><li><span style="font-family: arial;">To decrease unnecessary documentation in the medical record that may not be pertinent to the patient’s care</span></li></ul><ul style="text-align: left;"><li><span style="font-family: arial;">To ensure that payment for E/M is resource-based and that there is no direct goal for payment redistribution between specialties</span></li></ul><span style="font-family: arial;"><br /></span><div><h4 class="elementor-heading-title elementor-size-default" style="background-color: white; border: 0px; box-sizing: border-box; clear: both; color: #2026a9; font-family: Montserrat, sans-serif; font-size: 1.42857rem; font-weight: 400; line-height: 1.5; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">On-Demand Course Agenda</h4></div></div></div><div><div><span style="font-family: arial;"><br /></span></div><div><b style="font-family: arial;">Approved by the AAPC for 3 hours of CEUs - $6.99</b></div><div><b style="font-family: arial;"><br /></b></div><div><span style="font-family: arial;">Lesson 1 – Introduction</span></div><div><span style="font-family: arial;"><br /></span></div><div><span style="font-family: arial;">Lesson 2 – 2021 E/M Guidelines and Key Terms</span></div><div><ul style="text-align: left;"><li><span style="font-family: arial;">Guidelines Common to all E/M Services</span></li><li><span style="font-family: arial;">Services Reported Separately</span></li><li><span style="font-family: arial;">Guidelines for Office or Other Outpatient Services</span></li><li><span style="font-family: arial;">MDM Element Definitions</span></li></ul></div><div><span style="font-family: arial;"><br /></span></div><div><span style="font-family: arial;">Lesson 3 – Selecting the Level of E/M Services</span></div><div><ul style="text-align: left;"><li><span style="font-family: arial;">Instructions</span></li><li><span style="font-family: arial;">New Patient Codes</span></li><li><span style="font-family: arial;">Established Patient Codes</span></li></ul></div><div><span style="font-family: arial;"><br /></span></div><div><span style="font-family: arial;">Lesson 4 – Prolonged Services</span></div><div><ul style="text-align: left;"><li><span style="font-family: arial;">Without Direct Patient Contact</span></li><li><span style="font-family: arial;">Prolonged Clinical Staff Services</span></li></ul></div><div><span style="font-family: arial;"><br /></span></div><div><span style="font-family: arial;">Lesson 5 – Frequently Asked Questions</span></div><div><span style="font-family: arial;"><br /></span></div><div><span style="font-family: arial;"><br /></span></div><div><span style="font-family: arial;"><b>Instructions:</b></span></div><div><ol style="text-align: left;"><li><span style="font-family: arial;">Register for a FREE account on <a href="https://erm365.org/" target="_blank">ERM365</a> (if you do not already have one)</span></li><li><span style="font-family: arial;">Register for the <a href="https://erm365.org/courses/master-e-m-coding-for-2021/" target="_blank">course</a> </span></li><li><span style="font-family: arial;">Complete the lessons</span></li><li><span style="font-family: arial;">Pass the post test</span></li><li><span style="font-family: arial;">Print your CEU certificate</span></li></ol><div><span style="font-family: arial;"><br /></span></div></div></div><div><span style="font-family: arial;"><br /></span></div><div><span style="font-family: arial;">View more courses on <a href="https://erm365.org/" target="_blank">ERM365</a></span></div><div><br /></div><div><br /></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-74981244145178936822021-03-12T12:23:00.000-08:002021-03-12T12:23:00.509-08:00Advanced Risk Management and HCC Coding for Value Based Payments On-Demand<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/" imageanchor="1" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="767" data-original-width="1362" height="289" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcq4UW_uNOsvcM6-cV4_626t8HuLBaBkfUjLhcxwqjp0_DrVl40s0rXz_EFc4vb6MpWCCXzcFi4xvldkcgtRsmMRq4sPrIFCoiuTXMiK46NwTTauAeBaXsDywN2BhqiFJN3isCu6N42MKR/w514-h289/ARM+OnDemand.png" width="514" /></a></div><br /><p></p><h4 style="background-color: #fefdfa; color: #d52a33; font-family: Georgia, Utopia, "Palatino Linotype", Palatino, serif; font-size: 22px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal; margin: 0px; position: relative;"><b><a href="https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/" style="color: #d52a33; text-decoration-line: none;" target="_blank">Advanced Risk Management and HCC Coding for Value Based Payments On-Demand</a></b></h4><p class="MsoNormal" style="background-color: #fefdfa; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px;">Join us on-demand for this event recorded on 11/13/2020. This course is an advanced course on risk adjustment and HCC coding for coders, physicians and other healthcare professionals.<o:p></o:p></p><p class="MsoNormal" style="background-color: #fefdfa; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px;">Approved by the AAFP and AMA for 5 CMEs and the AAPC for 7 hours CEUs – only $49.00</p><p class="MsoNormal" style="background-color: #fefdfa; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px;"><a href="https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/" style="color: #d52a33; text-decoration-line: none;" target="_blank">https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/</a><o:p></o:p></p><p style="background-color: #fefdfa; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px;"></p><p style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-style: inherit; font-weight: 700;"><br /></span></p><p style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-style: inherit; font-weight: 700;">KEY TOPICS INCLUDE:</span></p><ul style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: Montserrat, sans-serif; font-size: 14px; line-height: 1.4; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Vast changes are coming to Medicare risk adjustment in 2021 and beyond. Is your team ready? What are the potential impacts to your revenue?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Discuss the importance of managing HCCs year over year. What resources are available from CMS to help?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are the components of a risk score and how is it calculated? What is the impact of the payment count?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Review NEW HCCs and see what documentation is needed to validate payment.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Simple steps for optimizing risk adjustment operations and associated revenue.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. See what your team should and should not be coding.<span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </span></li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><br /></span></p><p style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">WHO SHOULD ATTEND?</span></p><ul style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: Montserrat, sans-serif; font-size: 14px; line-height: 1.4; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Physicians and Other Providers</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Coders, CDI Specialists and Auditors</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Nurses, Medical Assistants and Scribes</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Medical Directors and CIOs</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">MA, Medicaid and Commercial Plans</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">ACO, MSO and IPA Teams</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Hospitals and Academic Centers</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Community Health, RHCs and FQHCs</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Health Alliance Members</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">PRICE:</span> $49</p><p style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-style: inherit; font-weight: 700;">On Demand Course Instructions for CEUs:</span></p><ol style="background-color: white; border: 0px; box-sizing: border-box; color: #333333; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/" style="color: #d52a33; text-decoration-line: none;" target="_blank">Purchase the course </a></li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Download the handouts</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Watch the video</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Pass the post test</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Download CEU Certificate</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Submit post course survey</li></ol><div style="background-color: #fefdfa; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px;"><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><h4 style="background-color: #fefdfa; color: #d52a33; font-family: Georgia, Utopia, "Palatino Linotype", Palatino, serif; font-size: 22px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal; margin: 0px; position: relative;"><span face="Montserrat, sans-serif"><span style="font-size: 14px;">Would you prefer to attend a LIVE event? We have several upcoming LIVE events - view the schedule and/or register here <a href="https://erm365.org/events/" style="color: #d52a33; text-decoration-line: none;">https://erm365.org/events/</a></span></span></h4><div><span face="Montserrat, sans-serif"><br /></span></div><div><span face="Montserrat, sans-serif"><br /></span></div><div><span face="Montserrat, sans-serif"><br /></span></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1tag:blogger.com,1999:blog-4916783830942487270.post-6276347819073529632021-03-10T10:36:00.006-08:002021-03-10T10:40:52.357-08:002021 CMS-HCC Coding Books and Tools<p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://erm.ecwid.com/" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="751" data-original-width="1332" height="333" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRGF_upw1XN21Dt0SgTTIiWvGWJTNRZesnUSxxxEx5UJ5TR31vvEciEYM0Yv7mLH666qfVFSmTh66wg81UIE5zXNN3cpLOmvyzXjjXjsHpR9E8nTm34YD2Gsf4aGJ0UeGrzP9IJ6q6QLTt/w592-h333/2021+HCC+Coding+Tools.png" width="592" /></a></div><br /> <p></p><div class="cover__title" style="background-color: white; box-sizing: border-box; grid-row: 2 / auto; margin-bottom: 20px; text-align: center;"><div class="content" style="box-sizing: border-box;"><h3 style="box-sizing: border-box; hyphens: auto; line-height: 1.05em; margin: 0px; opacity: 1; overflow-wrap: break-word; padding: 0px; text-shadow: rgba(0, 0, 0, 0.2) 0px 1px 1px; transition: opacity 0.1s ease-in-out 0s;"><span style="font-family: georgia; font-size: large;">Is Your Team <span style="box-sizing: border-box;">Risk Ready?</span></span></h3></div></div><div class="cover__subtitle cover-title--long" style="background-color: white; box-sizing: border-box; font-family: "Proxima Nova", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Arial, sans-serif; font-size: 3.5vw; grid-row: 3 / auto; margin-bottom: 40px; text-align: center;"><div class="content" style="box-sizing: border-box;"><h3 style="box-sizing: border-box; font-family: "Proxima Nova"; font-size: 22px; font-weight: 400; hyphens: auto; line-height: 1.3em; margin: 0px; opacity: 1; overflow-wrap: break-word; padding: 0px; text-shadow: rgba(0, 0, 0, 0.2) 0px 1px 1px; transition: opacity 0.1s ease-in-out 0s;">Arm Your Team For Combat This Risk <span style="box-sizing: border-box;">Adjustment Season!</span></h3><div><span style="box-sizing: border-box;"><br /></span></div><div><span style="box-sizing: border-box;"><h3 style="color: #333333; font-size: 30px; line-height: 1.3em; margin: 0px auto 16px; overflow-wrap: break-word; padding: 0px 8px;">Prepare for Victory...</h3><div class="description" style="box-sizing: border-box; color: #333333; font-size: 16px; line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px 8px; text-align: start;"><p style="line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">What will define those who claim victory and those who are defeated in the battle towards value based care? Will it be those organizations with the most money, power and seats at the table? Or will it be those who are nimble, flexible and open to change?</p><p style="line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">I believe it will be both. As victory will not be defined by the owners and head coaches but instead by how the players execute on the field. It will be the game time decisions that matter most. A quarterback who can read the defense and adjust accordingly will provide far greater value to the offense than the most athletic quarterback who misses the blitz every time.</p><p style="line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">Perhaps Napoleon said it best, "Battles are won by the power of the mind." For in a game of inches, the winners and losers will be defined by those who can execute in the moments that matter most. Prepare your team for victory with information at the point of care!</p><p style="line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;">Learn more / order here - <a href="https://erm.ecwid.com/">https://erm.ecwid.com/</a></p><p style="line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;"><br /></p><p style="line-height: 1.8em; margin: 16px auto; overflow-wrap: break-word; padding: 0px;"><br /></p></div></span></div></div></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1tag:blogger.com,1999:blog-4916783830942487270.post-21154933804724774972021-03-10T08:56:00.004-08:002021-03-10T08:57:18.959-08:00Creating Value in Health Care<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/courses/creating-value-in-health-care/" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="709" data-original-width="1066" height="331" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD2gMcTQM0rW4hzTjXDB930YUal_5nsUiGztOOwy-DpWTJr2SshTMIs9eg1jyGrAr2XhXg5OTk35h0iqTslI-IWSW9Tlw_5ginf5SSdZQdpcYekd5Quu0h7OiA2R5EtqhvGwNWY0haANLm/w497-h331/Creating+Value+in+Health+Care.png" width="497" /></a></div><br /><p></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: arial;">APPROVED by the AAPC for 4 CEUs - $12.99</span></span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: arial;">On-Demand Course Overview:</span></span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><em style="border: 0px; box-sizing: border-box; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">We insist on value when we buy our lunch, our car, our clothes, and our home. Why not in healthcare?</em></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">Since 2015, the US has been transitioning from a fee-for-service payment system to one based on value. This on-demand course will introduce the concepts of value-based care, population health and social determinants of health with highlights from Dr. Hart’s new book, “Value in Health Care”. By active creation of value in healthcare, we can rein in costs while improving quality outcomes and the experience of patients and providers. </p><div class="elementor-element elementor-element-79ca914 elementor-widget elementor-widget-text-editor" data-element_type="widget" data-id="79ca914" data-widget_type="text-editor.default" style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 20px; outline: 0px; padding: 0px; position: relative; vertical-align: baseline; width: 476.625px;"><div class="elementor-widget-container" style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; transition: background 0.3s ease 0s, border 0.3s ease 0s, border-radius 0.3s ease 0s, box-shadow 0.3s ease 0s, -webkit-border-radius 0.3s ease 0s, -webkit-box-shadow 0.3s ease 0s; vertical-align: baseline;"><div class="elementor-text-editor elementor-clearfix" style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><p style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">A journey toward sustainable healthcare with improved results.</span></p></div></div></div><div class="elementor-element elementor-element-e4603c6 elementor-widget elementor-widget-text-editor" data-element_type="widget" data-id="e4603c6" data-widget_type="text-editor.default" style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px; outline: 0px; padding: 0px; position: relative; vertical-align: baseline; width: 476.625px;"><div class="elementor-widget-container" style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; transition: background 0.3s ease 0s, border 0.3s ease 0s, border-radius 0.3s ease 0s, box-shadow 0.3s ease 0s, -webkit-border-radius 0.3s ease 0s, -webkit-box-shadow 0.3s ease 0s; vertical-align: baseline;"><div class="elementor-text-editor elementor-clearfix" style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><p style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><em style="border: 0px; box-sizing: border-box; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">“When we identify individual-level social risk factors, we can devise interventions to address them specifically or collect data to understand where community-level interventions might improve a population’s health.”</em></p><p style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">— Jon Hart, MD MBA</p></div></div></div><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><br /></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><b>Course Instructions </b></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"></p><ol style="text-align: left;"><li><span style="font-family: arial;">Register <a href="https://erm365.org/courses/creating-value-in-health-care/" target="_blank">today</a> and complete at your own pace. </span></li><li><span style="font-family: arial;">Complete the course. </span></li><li><span style="font-family: arial;">Pass the post test. </span></li><li><span style="font-family: arial;">Download your certificate. </span></li></ol><p></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><br /></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><b><span style="font-family: arial;">Link to Register</span></b></p><p style="background-color: white; border: 0px; box-sizing: border-box; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-size: 14px;"><a href="https://erm365.org/courses/creating-value-in-health-care/"><span style="font-family: arial;">https://erm365.org/courses/creating-value-in-health-care/</span></a></span></p><div><span style="font-family: arial;"><br /></span></div><div><span style="font-family: arial;">View more courses on <a href="http://www.erm365.org" target="_blank">ERM365</a></span></div><div><br /></div><div><br /></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-31979748603239725472021-02-20T11:39:00.006-08:002021-02-20T11:40:21.946-08:00Opioid Use Disorder<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/opioid-use-disorder/" imageanchor="1" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="801" data-original-width="618" height="417" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMTQx3IASiF1TDE29rcoOwMYwv3FNOnrXIcb1LP8A41oivHSmJvD7vVqVabsl_EB6lILQDzkhnC2F-_l3ypkQBThWgup2BRUzWNFwpwWfyh2kRFzqfFNcjhMG-FIFlO7M-h7FI-e1usNZc/w322-h417/OUD+DSM5+Criteria.png" width="322" /></a></div><br /><p></p><p><span style="background-color: white; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; font-style: inherit; font-weight: 700;">Opioid Use Disorder is defined by the DSM-5 as a “problematic pattern of opioid use…”</span></p><ul style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">A code of F11.20, opioid dependence, should not be assigned for patients taking pain medication as prescribed.</li></ul><ul style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Instead a code of Z79.891, long term use of opiates, should be assigned.</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">Coders should always be mindful of ICD-10 Guidelines and Coding Clinic Guidance when assigning codes for substance use disorder.</p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">2021 ICD-10 Guidelines (pages 43-44)</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)</p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">b. Mental and behavioral disorders due to psychoactive substance use</p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">3. Psychoactive Substance Use, Unspecified<br style="box-sizing: border-box;" />As with all other unspecified diagnoses, the codes for unspecified psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-, F18.9-, F19.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). These codes are to be used only when the psychoactive substance use is associated with a physical disorder included in chapter 5 (such as sexual dysfunction and sleep disorder), or a mental or behavioral disorder, and such a relationship is documented by the provider.</p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">AHA Coding Clinic Guidance</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Question:</span><br style="box-sizing: border-box;" />Medical record documentation indicates the patient is taking opioids prescribed by their physician for treatment of chronic pain. Does Guideline I.C.5.b.3. mean that codes cannot be assigned for the opioid use unless there is documentation of an associated physical, mental or behavioral disorder?</p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Answer:</span><br style="box-sizing: border-box;" />A code for the use of prescription opiates would not be reported because there is no associated physical, mental or behavioral disorder.</p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><em style="border: 0px; box-sizing: border-box; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Reference: AHA Coding Clinic 2018 2nd Quarter, pages 11 and 12</em></p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">Learn more or download a copy of DSM-5 Criteria here <a href="https://erm365.org/opioid-use-disorder/">https://erm365.org/opioid-use-disorder/</a></p><p style="background-color: white; border: 0px; box-sizing: border-box; color: rgba(12, 12, 13, 0.93); font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><br /></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1tag:blogger.com,1999:blog-4916783830942487270.post-30124288600410689702021-02-13T09:42:00.007-08:002021-02-13T09:48:52.760-08:00Looking for an MRA Coding Tool?<div class="separator" style="clear: both; text-align: left;"><h3 style="clear: both; text-align: left;"><b><span style="font-family: arial;">2021 CMS-HCC Coding Tool Example</span></b></h3><div class="separator" style="clear: both;"><span style="font-family: arial;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: arial;">We have received several requests from physicians, coders and administrators for an “MRA Cheat Sheet”.</span></div><div class="separator" style="clear: both;"><span style="font-family: arial;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: arial;">Many have asked for something that is a single page or similar in format to a “charge slip”. </span></div><div class="separator" style="clear: both;"><span style="font-family: arial;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: arial;">So, I wanted to share a simple example of one that could be used for primary care providers. </span></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;"><span style="font-family: arial;"><a href="https://erm365.org/2021-cms-hcc-coding-tool/" target="_blank">View or download below. </a></span></div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/2021-cms-hcc-coding-tool/" imageanchor="1" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="781" data-original-width="604" height="455" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9Fiha1gVtpmFNfAUu_vQVuqbWJgVdv_UB9GkEdQRV2aOxjN03gXGDXiX1VHLLUyphnqP0YhBUMuG5jn8bEiAKq_btjVVxQIlV0knAWAmepLioSh69pBf3lMN7MejBSxlcAhwZE0uzHZf8/w352-h455/2021+CMS-HCC+Coding+Tool.png" width="352" /></a></div><div><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial;">Visit <a href="http://www.ERM365.org">www.ERM365.org</a> for more risk adjustment tools and information!</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial;"><br /></span></div><p></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com2tag:blogger.com,1999:blog-4916783830942487270.post-29733674877911334092021-01-24T05:22:00.007-08:002021-01-24T05:27:58.144-08:00Advanced Risk Adjustment and HCC Coding for Value Based Payments<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAYzyqdi5U55ISKmEMPoGqiG5CN-8qGZtc596MYluy_6Kyz8WdAaZo2lApdEkGspb6m0o5jwFqKTtfegAbryrEL5GCc0Z5kk8VHTs8QJvcUmgrGu86XV4rSFk-3vT_glroMGPwSJUcD9Jg/s998/ARM+schedule+2021.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="543" data-original-width="998" height="326" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAYzyqdi5U55ISKmEMPoGqiG5CN-8qGZtc596MYluy_6Kyz8WdAaZo2lApdEkGspb6m0o5jwFqKTtfegAbryrEL5GCc0Z5kk8VHTs8QJvcUmgrGu86XV4rSFk-3vT_glroMGPwSJUcD9Jg/w599-h326/ARM+schedule+2021.png" width="599" /></a></div><div><br /></div><div><h3 style="text-align: left;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 107%;"><br /></span></h3><h3 style="text-align: left;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 107%;">Due to extremely high demand, new dates have been added for
the 2021 workshops! </span></h3>
<p class="MsoNormal"><b><span face=""Arial",sans-serif"><br /></span></b></p><p class="MsoNormal"><b><span face=""Arial",sans-serif">KEY TOPICS
INCLUDE:</span></b></p>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Vast changes
are coming to Medicare risk adjustment in 2022 and beyond. Is your team ready?<o:p></o:p></span></p>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">What are the
potential impacts to your revenue without RAPS? <o:p></o:p></span></p>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Discuss the
importance of managing HCCs year over year. What resources are available from
CMS to help?<o:p></o:p></span></p>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">What are the
components of a risk score and how is it calculated? What is the impact of the
payment count?<o:p></o:p></span></p>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Review NEW HCCs
and see what documentation is needed to validate payment. <o:p></o:p></span></p>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Simple steps
for optimizing risk adjustment operations and associated revenue. <o:p></o:p></span></p>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Take a deep
dive into the grey areas and red flags of HCC coding and clinical
documentation. See what your team should and should not be coding.</span></p><p class="MsoNormal"><span face=""Arial",sans-serif"><br /></span></p><p class="MsoNormal"><b><span face=""Arial",sans-serif">WHO SHOULD
ATTEND?<o:p></o:p></span></b></p><p class="MsoNormal"></p><ul style="text-align: left;"><li><span face=""Arial",sans-serif" style="font-family: arial;">Physicians and
Other Providers</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">Coders, CDI
Specialists and Auditors</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">Nurses, Medical
Assistants and Scribes</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">Medical
Directors and CIOs</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">MA, Medicaid
and Commercial Plans</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">ACO, MSO and
IPA Teams</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">Hospitals and
Academic Centers</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">Community
Health, RHCs and FQHCs</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">Health Alliance
Members</span></li></ul><p></p><p class="MsoNormal"><b><span face=""Arial",sans-serif"><br /></span></b></p><p class="MsoNormal"><b><span face=""Arial",sans-serif">EACH ATTENDEE
WILL RECEIVE:<o:p></o:p></span></b></p><div>
<p class="MsoNormal"></p><ul style="text-align: left;"><li><span face=""Arial",sans-serif" style="font-family: arial;">Color
Presentation</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">CME / CEU / CE Certificate
(Approved by the AAPC, AMA, AAFP and CCMC)</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">HCC Coding
Tools Download</span></li><li><span face=""Arial",sans-serif" style="font-family: arial;">25% off any HCC
Tools ordered within 14 days of the event.</span></li></ul><p></p><p class="MsoNormal"><b><span face=""Arial",sans-serif"><br /></span></b></p><p class="MsoNormal"><b><span face=""Arial",sans-serif">HOW DO I
REGISTER?<o:p></o:p></span></b></p><div>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Register here
for <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138788914">Friday,
February 19, 2021</a><o:p></o:p></span></p>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Register here
for <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138788914">Friday,
March 26, 2021</a><o:p></o:p></span></p>
<p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Register here
for <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138784928">Friday,
April 23, 2021</a><o:p></o:p></span></p>
<p class="MsoNormal"><span face=""Arial",sans-serif"><span style="font-family: arial;">Register here
for <a href="https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138784931">Friday,
May 28, 2021</a></span><o:p></o:p></span></p><p class="MsoNormal"><b><span face=""Arial",sans-serif"><br /></span></b></p><p class="MsoNormal"><b><span face=""Arial",sans-serif">WHAT IS THE
COST? <o:p></o:p></span></b></p><p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Tickets - $49 <o:p></o:p></span></p><p class="MsoNormal">
</p><p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Bring the Whole
Team and SAVE 10% on 3 or more tickets!!<o:p></o:p></span></p><p class="MsoNormal"><span face=""Arial",sans-serif"><br /></span></p><p class="MsoNormal"><b><span face=""Arial",sans-serif">WHERE CAN I
LEARN MORE?<o:p></o:p></span></b></p><p class="MsoNormal">
</p><p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;">Visit ERM365 (<a href="http://www.erm365.org/events">www.erm365.org/events</a>) to learn more.</span></p><p class="MsoNormal"><span face=""Arial",sans-serif" style="font-family: arial;"><a href="https://erm365.org/wp-content/uploads/2021/01/ARM-Workshops-2021-1.pdf" target="_blank">Download the agenda / flyer </a><o:p></o:p></span></p><p class="MsoNormal"><span face=""Arial",sans-serif"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEqmDOcoOKL9ZjcOvR7U3Xdr6WGxgyLxqppzUfqHmyZeLiPZ5Mh8dlYIsTQ2NPv7puC6mbjqp0HCYFeQVrow2OQfjj0fUVg6tATWNr7ohXAZdsGN6DuiNqAXBSuL-UAfoiZ0B411PVJ7i_/s954/ARM+Past+Attendees+2021.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="564" data-original-width="954" height="357" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEqmDOcoOKL9ZjcOvR7U3Xdr6WGxgyLxqppzUfqHmyZeLiPZ5Mh8dlYIsTQ2NPv7puC6mbjqp0HCYFeQVrow2OQfjj0fUVg6tATWNr7ohXAZdsGN6DuiNqAXBSuL-UAfoiZ0B411PVJ7i_/w604-h357/ARM+Past+Attendees+2021.png" width="604" /></a></div><br /><span face=""Arial",sans-serif"><br /></span><p></p><p class="MsoNormal"><span face=""Arial",sans-serif"><br /></span></p><p class="MsoNormal"><span face=""Arial",sans-serif"><br /></span></p></div>
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</p></div><p></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-86168578946982367942021-01-09T05:05:00.000-08:002021-01-09T05:05:03.819-08:00Medicare Risk Adjustment Operations<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKs9L52hpy98UAbd1BWptKUBMyqvVYihomIs2hgRWQ8gi8lUJCuCMTPC1L4E7UWc5TO1jbumZ_ExytmSJoXuY4bOLAbQgUY0GqYpW60Xk9oq4hHzepDUiW5HcLjke8JANIj1mrqvhU8fbP/s932/Medicare+Risk+Adjustment+Operations.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="627" data-original-width="932" height="314" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKs9L52hpy98UAbd1BWptKUBMyqvVYihomIs2hgRWQ8gi8lUJCuCMTPC1L4E7UWc5TO1jbumZ_ExytmSJoXuY4bOLAbQgUY0GqYpW60Xk9oq4hHzepDUiW5HcLjke8JANIj1mrqvhU8fbP/w467-h314/Medicare+Risk+Adjustment+Operations.png" width="467" /></a></div><br /><p></p><p><b style="font-family: Montserrat, sans-serif; font-size: 14px;">APPROVED by the AAPC for 5 CEUs</b></p><p><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">Course Overview</span></p><p><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">Medicare Advantage (MA) is one of the fastest-growing and most complex health plan lines of business representing significant growth opportunities for payers. Launching and/or managing a successful MA market requires careful, strategic planning to meet requirements, ensure compliance, and maximize the program benefits for your organization.</span></p><p><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">Success in this market will depend on success in each of the following essential areas:</span></p><p></p><ul style="text-align: left;"><li><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">Value-based contracting</span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Clinical documentation and coding</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Delivering high quality care</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Managing utilization</span></span></li></ul><p></p><p><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">This course will touch on all four essential areas of MRA Operations.</span></p><p><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">Learn more or Register <a href="https://erm365.org/courses/medicare-risk-adjustment-operations/" target="_blank">here</a></span></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;"><br /></span></span></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;"><b>Review the Agenda below:</b></span></span></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;"><br /></span></span></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Risk Adjustment Operations</span></span></p><p></p><ul style="text-align: left;"><li><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">Medicare Risk Adjustment Overview</span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">History of Medicare Risk Adjustment</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Key Concepts and Terms</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Risk Adjustment Data</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Risk Adjustment Process</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Risk Adjustment Data Validation</span></span></li></ul><p></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;"><br /></span></span></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">CMS-HCC Risk Models</span></span></p><p></p><ul style="text-align: left;"><li><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">PY 2020 CMS HCC Risk Adjustment Model</span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">PY 2021 CMS HCC Risk Adjustment Model</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">PY 2022 CMS HCC Risk Adjustment Model</span></span></li></ul><p></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;"><br /></span></span></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Calculating Risk Scores and Payments</span></span></p><p></p><ul style="text-align: left;"><li><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">General Payment Rules</span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Data Submissions and Payments</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">PY 2020 Risk Score Calculations</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">PY 2020 CMS-HCC Payment Calculation Example</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">PY 2021 Risk Score Calculations</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">PY 2021 CMS-HCC Payment Calculation Example</span></span></li></ul><p></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;"><br /></span></span></p><p><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Optimizing RA Operations</span></span></p><p></p><ul style="text-align: left;"><li><span style="background-color: white; font-family: Montserrat, sans-serif; font-size: 14px;">Network Adequacy Guidance</span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Medicare Star Ratings</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Growth and Retention</span></span></li><li><span style="font-family: Montserrat, sans-serif;"><span style="background-color: white; font-size: 14px;">Reports and Resources</span></span></li></ul><div><span style="font-family: Montserrat, sans-serif;"><span style="font-size: 14px;"><br /></span></span></div><div><span style="font-family: Montserrat, sans-serif;"><span style="font-size: 14px;">Visit <a href="https://erm365.org/" target="_blank">www.ERM365.org </a>to see more courses. </span></span></div><div><span style="font-family: Montserrat, sans-serif;"><span style="font-size: 14px;"><br /></span></span></div><div><span style="font-family: Montserrat, sans-serif;"><span style="font-size: 14px;"><br /></span></span></div><div><span style="font-family: Montserrat, sans-serif;"><span style="font-size: 14px;"><br /></span></span></div><p></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1tag:blogger.com,1999:blog-4916783830942487270.post-43662969462421818892021-01-08T09:54:00.003-08:002021-01-08T09:54:52.874-08:00MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline Extended to February 1, 2021<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgenzGJfV83Ysz-OUpu938VamhIISIBDIolIrWygCZLq_5Ntagdfmu4I91Y9TlYei4t9E7Rs9nYv_8bpADss9mR5P22dBMB6aBNEblb3L_GgoFc01wTX2KeaaVbnyKdmaEC98HbujoAysKC/s1280/clock-4571957_1280.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="853" data-original-width="1280" height="289" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgenzGJfV83Ysz-OUpu938VamhIISIBDIolIrWygCZLq_5Ntagdfmu4I91Y9TlYei4t9E7Rs9nYv_8bpADss9mR5P22dBMB6aBNEblb3L_GgoFc01wTX2KeaaVbnyKdmaEC98HbujoAysKC/w435-h289/clock-4571957_1280.jpg" width="435" /></a></div><br /><span style="box-sizing: border-box; font-family: Arial, sans-serif; font-size: 12pt;"><br /></span><p></p><p><span style="box-sizing: border-box; font-family: Arial, sans-serif; font-size: 12pt;">For the 2020 performance year, MIPS eligible clinicians, groups, and virtual groups can </span><a href="https://qpp.cms.gov/mips/exception-applications#extremeCircumstancesException-2020" style="box-sizing: border-box; color: #496ea4; font-family: Roboto; font-size: 16px; text-decoration-line: none; transition: all 0.4s ease 0s;"><span style="box-sizing: border-box; font-family: Arial, sans-serif; font-size: 12pt;">submit an application</span></a><span style="box-sizing: border-box; font-family: Arial, sans-serif; font-size: 12pt;"> to the Centers for Medicare and Medicaid Services (CMS) asking the agency to re-weight one or more performance categories to 0% due to the COVID-19 public health emergency. This means if you have concerns about the impact of the COVID-19 public health emergency on your performance data – including cost measures – you can submit an application to CMS and cite COVID-19 as the reason for your application.</span></p><p class="MsoNormal" style="background-color: white; box-sizing: border-box; color: #222222; font-family: Roboto; font-size: 16px; margin: 0px 0px 17px;"><span style="box-sizing: border-box; color: black; font-family: Arial, sans-serif; font-size: 12pt;">CMS has </span><a href="https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-12-10-mlnc#_Toc58396425" style="background-color: transparent; box-sizing: border-box; color: #496ea4; text-decoration-line: none; transition: all 0.4s ease 0s;"><span style="box-sizing: border-box; font-family: Arial, sans-serif; font-size: 12pt;">recently announced</span></a><span style="box-sizing: border-box; color: black; font-family: Arial, sans-serif; font-size: 12pt;"> that it will be extending the deadline for COVID-19-related 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception applications to February 1, 2021.</span></p><p style="background-color: white; box-sizing: border-box; color: #222222; font-family: Roboto; font-size: 16px; margin: 7.5pt 0in;"><span style="box-sizing: border-box; color: black; font-family: Arial, sans-serif; font-size: 12pt;">If you have concerns about the effect the COVID-19 public health emergency will have on your performance data for the 2020 performance period, including cost measures, <span style="box-sizing: border-box;"> </span></span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDAsInVyaSI6ImJwMjpjbGljayIsImJ1bGxldGluX2lkIjoiMjAyMDEyMTcuMzIxOTExMjEiLCJ1cmwiOiJodHRwczovL3FwcC5jbXMuZ292L21pcHMvZXhjZXB0aW9uLWFwcGxpY2F0aW9ucyNleHRyZW1lQ2lyY3Vtc3RhbmNlc0V4Y2VwdGlvbi0yMDIwIn0.zzCGRKrZKVY0TZfD2-mbHCNNgOi5KmAM_dSf-s4t_tg/s/77301182/br/92054603994-l" style="background-color: transparent; box-sizing: border-box; color: #496ea4; text-decoration-line: none; transition: all 0.4s ease 0s;"><span style="box-sizing: border-box; color: #3b36ad; font-family: Arial, sans-serif; font-size: 12pt;">submit an application now</span></a> <span style="box-sizing: border-box; color: black;"><span style="box-sizing: border-box; font-family: Arial, sans-serif; font-size: 12pt;"><span style="box-sizing: border-box;">and make sure you cite COVID-19 as the reason for your application.</span> </span><i style="box-sizing: border-box;"><span style="box-sizing: border-box; font-family: Arial, sans-serif; font-size: 12pt;">The deadline to submit a MIPS Promoting Interoperability Performance Category Hardship Exception application or an Extreme and Uncontrollable Circumstances application</span></i></span><span style="box-sizing: border-box; font-family: Arial, sans-serif; font-size: 12pt;"><span style="box-sizing: border-box; color: black;"> <i style="box-sizing: border-box;">not related to COVID-19 remained December 31, 2020</i>. If you are already exempt from reporting Promoting Interoperability data, you don’t need to apply.</span><span style="box-sizing: border-box; font-weight: 700;"></span></span></p><p style="background-color: white; box-sizing: border-box; color: #222222; font-family: Roboto; font-size: 16px; margin: 7.5pt 0in;"><span style="box-sizing: border-box; color: black; font-family: Arial, sans-serif; font-size: 12pt;">Once you have an approved application, you can still receive scores for the Quality, Improvement Activities and Promoting Interoperability performance categories if you submit data. If the Cost performance category is included in your approved application, you will not be scored on cost measures even if other data are submitted. <span style="box-sizing: border-box;">It is important to note that you cannot </span>submit an application to override data for program year 2020 that has already been submitted and any data submitted either before or after an application has been approved will be scored. </span></p><p style="background-color: white; box-sizing: border-box; color: #222222; font-family: Roboto; font-size: 16px; margin: 7.5pt 0in;"><span style="box-sizing: border-box; color: black; font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></p><p style="background-color: white; box-sizing: border-box; color: #222222; font-family: Roboto; font-size: 16px; margin: 7.5pt 0in;"><span style="box-sizing: border-box; color: black; font-family: Arial, sans-serif; font-size: 12pt;"><a href="https://www.policymed.com/2021/01/mips-extreme-and-uncontrollable-circumstances-exception-application-deadline-extended-to-february-1-2021.html">MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline Extended to February 1, 2021 – Policy & Medicine</a></span></p><p style="background-color: white; box-sizing: border-box; color: #222222; font-family: Roboto; font-size: 16px; margin: 7.5pt 0in;"><br /></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1tag:blogger.com,1999:blog-4916783830942487270.post-57526071776729614102020-11-21T09:52:00.006-08:002020-11-21T09:54:18.354-08:00Let’s Talk About Risk On-Demand<p> </p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/courses/lets-talk-about-risk-on-demand/" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="777" data-original-width="1384" height="331" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUPVwVzafEnMZvhO3P0bJEQcXBRGvYwozvGYyRz1Z_3UspXdYlmkeLOzl3RUObh5AfHeqXF5xujCvTVcGDXhJQymWkWSLiD82XhOTekH2vEnWl8l0ryVG4mL_D1pdtV9WvXqdS8YT2XVMz/w587-h331/Let%2527s+Talk+About+Risk+On+Demand.png" width="587" /></a></div><br /><b><br /></b><p></p><h4 style="text-align: left;"><b>Let’s Talk About Risk On-Demand</b></h4>
<p class="MsoNormal">Join us on-demand for this event recorded 11/11/2020. The
presentation is an introduction to risk adjustment and HCC coding for coders,
physicians and other healthcare professionals. <o:p></o:p></p>
<p class="MsoNormal">Approved by the AAPC for 2 CEUs - only $14.99<o:p></o:p></p>
<p class="MsoNormal"><a href="https://erm365.org/courses/lets-talk-about-risk-on-demand/">https://erm365.org/courses/lets-talk-about-risk-on-demand/</a><o:p></o:p></p><p class="MsoNormal"><br /></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-style: inherit; font-weight: 700;">Review the Agenda:</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: underline; vertical-align: baseline;">Section 1 – Risk Adjustment Basics</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">This section will cover basic concepts and terminology in the CMS-HCC Model of Risk Adjustment.</p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What is an HCC?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Why are HCCs important?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">How is a risk score calculated?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What is the value of an HCC?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are the most common HCCs?</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: underline; vertical-align: baseline;">Section 2 – Rules of the Road</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">This section will cover ICD-10 Guidelines and other “rules” related to clinical documentation and coding within the CMS-HCC Model of Risk Adjustment.</p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">When should a diagnosis be coded?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">How often can a diagnosis be coded</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What clinical documentation is needed to support the diagnosis?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Is it okay to code for resolved conditions?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Would it be acceptable to code a diagnosis documented as “suspected” in an outpatient setting such as a provider’s office?</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: underline; vertical-align: baseline;">Section 3 – HCC Coding</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">This section will review the most common HCC’s for Medicare enrollees based on MedPAC data.</p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are the twenty most common HCC categories for Medicare enrollees?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are the most common ICD-10 codes included in each category?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">How can clinical documentation impact code selection?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are common errors leading to inaccurate risk scores?</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: underline; vertical-align: baseline;">Section 4 – Tips for Success</span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;">This section will cover simple tips that will make a big impact. At the end of this lesson you will be able to work smarter not harder.</p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What should be included in the problem list?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Why does clinical documentation need to clarify active vs. history of?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What small changes can you start making today that will have a big impact on the accuracy of your risk scores?</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"> </p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="box-sizing: border-box; font-weight: 700;">Who Should Attend? </span></p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Coders, Billers, and Auditors</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Physicians, NPs and PAs</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Medical Assistants and Front Office</li></ul><div style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </div><div style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="box-sizing: border-box; font-weight: 700;">Price:</span> $14.99</div><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Purchase includes a copy of the presentation and other resources. </li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">180 days of access to course and materials. </li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"> </p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">On Demand Course Instructions for CEUs:</span></p><ol style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Login or Register for a FREE account with ERM365.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Purchase the course.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Click on “My Dashboard” and then “My Courses” to access.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Download the handouts and other resources.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Watch the video.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Pass the post quiz.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Download CEU Certificate. </li></ol><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;">Would you prefer to attend a LIVE event? Visit <a href="https://erm365.org/events/">https://erm365.org/events/</a> to view the schedule and register. </span></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><p class="MsoNormal"><br /></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1tag:blogger.com,1999:blog-4916783830942487270.post-3330212739128746432020-11-21T09:46:00.006-08:002020-11-21T09:47:58.230-08:00Advanced Risk Management and HCC Coding ON-DEMAND<p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="767" data-original-width="1362" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2-ATa9W0S7JLYRVoqR7gKai3qoCLkHpYx1u7Q8PG311htpPoVMbbvs2stRtWs68N73L2DTbv8-smK6vTWY76NuLWcd8FMHH7FXEyQ4xAkizvCzwUqi70HbheF9xGB0MIuksd7_5tYrNUH/w518-h292/ARM+OnDemand.png" width="518" /></a></div><br /> <p></p><p></p><h4 style="text-align: left;"><b><a href="https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/" target="_blank">Advanced Risk Management and HCC Coding for Value Based Payments On-Demand</a></b></h4>
<p class="MsoNormal">Join us on-demand for this event recorded on 11/13/2020.
This course is an advanced course on risk adjustment and HCC coding for coders,
physicians and other healthcare professionals. <o:p></o:p></p>
<p class="MsoNormal">Approved by the AAFP and AMA for 5 CMEs and the AAPC for 7
hours CEUs – only $49.00</p>
<p class="MsoNormal"><a href="https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/" target="_blank">https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/</a><o:p></o:p></p><p></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-style: inherit; font-weight: 700;"><br /></span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-style: inherit; font-weight: 700;">KEY TOPICS INCLUDE:</span></p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Vast changes are coming to Medicare risk adjustment in 2021 and beyond. Is your team ready? What are the potential impacts to your revenue?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Discuss the importance of managing HCCs year over year. What resources are available from CMS to help?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What are the components of a risk score and how is it calculated? What is the impact of the payment count?</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Review NEW HCCs and see what documentation is needed to validate payment.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Simple steps for optimizing risk adjustment operations and associated revenue.</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. See what your team should and should not be coding.<span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </span></li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><br /></span></p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">WHO SHOULD ATTEND?</span></p><ul style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Physicians and Other Providers</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Coders, CDI Specialists and Auditors</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Nurses, Medical Assistants and Scribes</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Medical Directors and CIOs</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">MA, Medicaid and Commercial Plans</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">ACO, MSO and IPA Teams</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Hospitals and Academic Centers</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Community Health, RHCs and FQHCs</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Health Alliance Members</li></ul><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: 700; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">PRICE:</span> $49</p><p style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; margin: 0px 0px 1.6em; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-style: inherit; font-weight: 700;">On Demand Course Instructions for CEUs:</span></p><ol style="background-color: white; border: 0px; box-sizing: border-box; font-family: Montserrat, sans-serif; font-size: 14px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;"><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/" target="_blank">Purchase the course </a></li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Download the handouts</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Watch the video</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Pass the post test</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Download CEU Certificate</li><li style="border: 0px; box-sizing: border-box; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Submit post course survey</li></ol><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><h4 style="text-align: left;"><span face="Montserrat, sans-serif"><span style="font-size: 14px;">Would you prefer to attend a LIVE event? We have several upcoming LIVE events - view the schedule and/or register here <a href="https://erm365.org/events/">https://erm365.org/events/</a></span></span></h4><div><span face="Montserrat, sans-serif"><br /></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><div><span face="Montserrat, sans-serif"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_d-j7mX4sI7E0BrxCA9VN1ZCOn4gaXcdrVX7HOLQ0N_IZZmcjnb5ZZ-gxZni7hq-FvpKsNsuQZ77c_ciJxwxjqQ0qpqCVRGi4F3fCwZukEWlPUBncU3kkhFovqpmTpPxG_MhHfVszOiZN/s873/ERM+ARM+Logos.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="420" data-original-width="873" height="297" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_d-j7mX4sI7E0BrxCA9VN1ZCOn4gaXcdrVX7HOLQ0N_IZZmcjnb5ZZ-gxZni7hq-FvpKsNsuQZ77c_ciJxwxjqQ0qpqCVRGi4F3fCwZukEWlPUBncU3kkhFovqpmTpPxG_MhHfVszOiZN/w617-h297/ERM+ARM+Logos.png" width="617" /></a></div><br /><span style="font-size: 14px;"><br /></span></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><div><span face="Montserrat, sans-serif"><span style="font-size: 14px;"><br /></span></span></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1tag:blogger.com,1999:blog-4916783830942487270.post-89820683732457821172020-10-22T04:52:00.000-07:002020-10-22T04:52:15.596-07:00HHS Extends COVID-19 Related Public Health Emergency Through January 20, 2021<p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuml7udkpozA32mERgm_ZSVGdlnAft-vVPqhqH2EaRvqxTHabDcSa1jLk1d6NXWrTmzQE389ihlfUqhAJk6XCJ9jtn-swAYBrtpIVk7dmjHh-1HzyKoIk1d_3mT0fF2ofVmoDDSnzjYEJa/s1280/public_health_emergency.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuml7udkpozA32mERgm_ZSVGdlnAft-vVPqhqH2EaRvqxTHabDcSa1jLk1d6NXWrTmzQE389ihlfUqhAJk6XCJ9jtn-swAYBrtpIVk7dmjHh-1HzyKoIk1d_3mT0fF2ofVmoDDSnzjYEJa/w640-h360/public_health_emergency.jpg" width="640" /></a></div><br /><p></p><div><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">On October 2, 2020, Health and Human Services (HHS) Secretary, Alex M. Azar II, <u><a href="https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-2Oct2020.aspx" style="background-color: transparent; box-sizing: border-box; color: rgb(27, 81, 124) !important; overflow-wrap: break-word; text-decoration-line: none !important;">announced</a></u> the renewal of the public health emergency declaration due to the continued consequences of the COVID-19 pandemic. The 90-day renewal is effective October 23, 2020, and extends until January 20, 2021.</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">The renewal impacts a number of regulatory flexibilities and temporary rules applicable to health care providers including, but not limited to, <span style="font-weight: bolder;">1135 Waivers</span>, <span style="font-weight: bolder;">HIPAA enforcement discretion</span><span style="font-weight: bolder;">, and fraud and abuse enforcement discretion</span> – all of which are effective only for the duration of the public health emergency.</p><ol style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px;"><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;"><span style="font-weight: bolder;">1135 Waivers</span></li></ol><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">Section 1135 of the Social Security Act grants HHS the power to waive and/or modify certain federal healthcare requirements during a federal emergency to (i) ensure individuals enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) have sufficient access to health care items and services and (ii) protect health care providers furnishing such items and services in good faith during emergency conditions against penalties for noncompliance.</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">Presently, HHS and the Centers for Medicare and Medicaid Services (CMS) have issued numerous <u><a href="https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf" style="background-color: transparent; box-sizing: border-box; color: rgb(27, 81, 124) !important; overflow-wrap: break-word; text-decoration-line: none !important;">“blanket” waivers</a></u> and state-specific <u><a href="https://www.medicaid.gov/resources-for-states/disaster-response-toolkit/federal-disaster-resources/index.html" style="background-color: transparent; box-sizing: border-box; color: rgb(27, 81, 124) !important; overflow-wrap: break-word; text-decoration-line: none !important;">Medicaid waivers</a></u> in connection with the COVID-19 public health emergency (including <u><a href="https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/Spotlight" style="background-color: transparent; box-sizing: border-box; color: rgb(27, 81, 124) !important; overflow-wrap: break-word; text-decoration-line: none !important;">waivers</a> </u>related to sanctions under the physician self-referral law (Stark Law) for COVID-19 purposes).</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">These waivers afford health care providers enhanced flexibility with regard to Medicare telehealth services, waive certain physician hospital privilege requirements/credentialing process requirements, and suspend many reporting requirements.</p><ol start="2" style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px;"><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;"><span style="font-weight: bolder;">HIPAA Enforcement Discretion</span></li></ol><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">The HHS Office of Inspector General (OIG) has issued various <u><a href="https://www.hhs.gov/hipaa/for-professionals/special-topics/hipaa-covid19/index.html" style="background-color: transparent; box-sizing: border-box; color: rgb(27, 81, 124) !important; overflow-wrap: break-word; text-decoration-line: none !important;">guidance</a> </u>providing for OIG enforcement discretion with regard to certain provisions of HIPAA (e.g., privacy, security, and breach notification rules) as it relates to permissible telehealth practices, business associates making disclosures for public health purposes, and community-based testing sites (CBTSs).</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">Note that in conjunction with the relaxation of certain federal HIPAA privacy and security rules during the public health emergency, health care providers should continue to be cognizant of compliance with other applicable state privacy laws to the extent they are still in effect.</p><ol start="3" style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px;"><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;"><span style="font-weight: bolder;">Fraud and Abuse Enforcement Discretion</span></li></ol><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">In connection with applicable HHS waivers, the HHS Office of Inspector General (OIG) has issued <u><a href="https://oig.hhs.gov/coronavirus/policy.asp" style="background-color: transparent; box-sizing: border-box; color: rgb(27, 81, 124) !important; overflow-wrap: break-word; text-decoration-line: none !important;">guidance</a></u> relaxing the imposition of administrative sanctions under the Anti-Kickback Statute and Stark Law for certain COVID-19 response activities (see also this <u><a href="https://oig.hhs.gov/fraud/docs/alertsandbulletins/2020/policy-telehealth-2020.pdf" style="background-color: transparent; box-sizing: border-box; color: rgb(27, 81, 124) !important; overflow-wrap: break-word; text-decoration-line: none !important;">OIG Policy Statement</a></u> regarding physicians and other practitioners that reduce or waive amounts owed by federal health care program beneficiaries for telehealth services during the public health emergency).</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;"><span style="font-weight: bolder;">Note that HHS retains the discretion to terminate the public health emergency at any time</span> <span style="font-weight: bolder;">and is not required and/or obligated to extend the present declaration beyond its January 20, 2021 expiration</span>. Accordingly, health care providers should be mindful of termination, expiration, and renewal timelines applicable to COVID-19 related emergency measures, which could immediately eliminate current regulatory flexibilities (such as the ones discussed herein).</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">[<a href="https://healthcarelawmatters.foxrothschild.com/2020/10/articles/covid-19-coronavirus/hhs-extends-covid-19-related-public-health-emergency-through-january-20-2021/" style="background-color: transparent; box-sizing: border-box; color: rgb(27, 81, 124) !important; overflow-wrap: break-word; text-decoration-line: none !important;" target="_blank">View source</a>.]</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">Visit www.erm365.org to learn more. </p></div><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com0tag:blogger.com,1999:blog-4916783830942487270.post-87029963278666002052020-10-20T09:07:00.002-07:002020-10-20T09:07:34.620-07:00CMS Proposes a Regulatory Definition of Medically "Reasonable and Necessary"<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBal8WMZvUZarYSBC7h1Al_IgmgstnTLdr_J3kM0txtQOzO7pOXPDiAFHQtHG4kKD3Bp0yrxaSH_ortZBq8MJpu0x19bYtbJcd2eHFTXKBB_1GuwZ-bKnJHLfflrXPEvDewlRGEuGdPrJ2/s899/Medical+necessity.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="547" data-original-width="899" height="244" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBal8WMZvUZarYSBC7h1Al_IgmgstnTLdr_J3kM0txtQOzO7pOXPDiAFHQtHG4kKD3Bp0yrxaSH_ortZBq8MJpu0x19bYtbJcd2eHFTXKBB_1GuwZ-bKnJHLfflrXPEvDewlRGEuGdPrJ2/w400-h244/Medical+necessity.png" width="400" /></a></div><p></p><p><span style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;">It has taken CMS more than 50 years, but the agency has finally</span><span style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;"> </span><a href="https://www.federalregister.gov/documents/2020/09/01/2020-19289/medicare-program-medicare-coverage-of-innovative-technology-mcit-and-definition-of-reasonable-and" style="box-sizing: border-box; color: rgb(27, 81, 124) !important; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px; overflow-wrap: break-word; text-decoration-line: none !important;" target="_blank">proposed</a><span style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;"> </span><span style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;">a regulatory definition for determining whether an item or service is "reasonable and necessary" for Medicare coverage purposes. Medicare Program; Medicare Coverage of Innovative Technology (MCIT) and Definition of "Reasonable and Necessary," 85 Fed. Reg. 54327 (Proposed Rule, September 1, 2020). This move comes in response to the President's October 3, 2019</span><span style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;"> </span><a href="https://www.federalregister.gov/documents/2019/10/08/2019-22073/protecting-and-improving-medicare-for-our-nations-seniors" style="box-sizing: border-box; color: rgb(27, 81, 124) !important; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px; overflow-wrap: break-word; text-decoration-line: none !important;" target="_blank">Executive Order 13890</a><span style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;"> </span><span style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;">directing the Secretary of HHS to ensure that Medicare beneficiaries have access to new cures and technologies that improve health outcomes. While CMS simultaneously seeks to establish a Medicare coverage pathway for medical devices designated as breakthrough by the FDA in this proposed rule, the proposed regulatory definition, including a possible consideration of whether an item or service is covered in the commercial insurance market, marks some progress toward clarifying when Medicare coverage is available. Comments to the proposed rule must be received by</span><span style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;"> </span><u style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;">November 2, 2020</u><span style="background-color: white; color: #292929; font-family: georgia, serif; font-size: 18px; font-weight: bolder; letter-spacing: 0.2px;">.</span></p><h3 style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.3em !important; margin-bottom: 0.5em !important; margin-top: 1.3em !important;">"Reasonable and Necessary"</h3><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">CMS explains that it is proposing to establish in regulations the factors it has historically used in making "reasonable and necessary" determinations under Section 1862(a)(1)(A), with "some modification." 85 Fed. Reg. at 54329. It acknowledged that stakeholders have expressed interest in codifying this definition for many years and that the proposed definition is "familiar and functional." 85 Fed. Reg. at 54328. The factors used by CMS for this purpose are set forth in the Medicare Program Integrity Manual (MPIM) and state that:</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">An item or service is considered "reasonable and necessary" if it is</p><ol style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; list-style-type: none;"><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">(1) safe and effective;</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">(2) not experimental or investigational; and</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">(3) appropriate, including the duration and frequency that is considered appropriate for the item or service, in terms of whether it is<ul style="box-sizing: border-box;"><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient's condition or to improve the function of a malformed body member;</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">furnished in a setting appropriate to the patient's medical needs and condition;</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">ordered and furnished by qualified personnel;</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">one that meets, but does not exceed, the patient's medical need; and</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">at least as beneficial as an existing and available medically appropriate alternative.</li></ul></li></ol><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">MPIM, CMS 100-08, ch. 13, § 13.5.4.</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">In addition to codifying the above criteria, CMS is proposing to include a separate basis under which an item or service would be "appropriate for Medicare patients" based on commercial health insurers' coverage policies (non-governmental entities that sponsor health insurance plans). And, CMS states that an "item or service deemed appropriate for Medicare coverage based on commercial coverage would be covered on that basis without also having to satisfy the bullets listed above." 85 Fed. Reg. at 54328.</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">By considering commercial health insurer coverage policies, CMS states that it would bring together the expertise of private payers and the Medicare program. Under this separate basis, CMS proposes that an item or service would satisfy factor (3) above if it is "covered under a plan(s) coverage policy if offered in the commercial insurance market, unless evidence supports that differences between Medicare beneficiaries and commercially insured individuals are clinically relevant." 85 Fed. Reg. at 54332. Under this proposal, CMS would exclude Medicaid managed care, Medicare Advantage, and other government administered health care coverage programs from the types of coverage CMS would consider, as these enrollees are not in the commercial market. CMS believes this definition is a "significant step in meeting the E.O.'s directive to bring clarity to coverage standards."</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">CMS specifically seeks comment on a myriad of issues related to this proposed definition, which include, among others, the following:</p><ul style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px;"><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">The sources of data that could be used to implement this policy;</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">The most appropriate source(s) for these coverage policies and best way to determine which commercial plan(s) it would rely on for Medicare coverage;</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">Whether beneficiaries, providers, innovators, or others wishing to gain coverage for an item or service demonstrate that the item or service is covered by at least one commercial insurance plan policy. If they can provide CMS with evidence of commercial coverage or if CMS or its MACs identify such coverage from its review of compilations of health insurance offerings or data from other sources, CMS would consider factor (3) to be satisfied;</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">Whether CMS should limit its consideration of commercial plan offerings or covered lives to a subset of the commercial market in the interest of simplicity, including looking at geographic subsets, subsets based on number of enrollees, subsets based on plan type (HMO, PPO, etc.), or other subsets of plans – including utilizing a singular plan; and</li><li style="box-sizing: border-box; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; padding-left: 5px;">Whether CMS should adopt the most or least restrictive coverage policy since commercial plans may impose certain restrictions on an item or service (related to clinical criteria, disease stage, or number and frequency of treatment).</li></ul><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">85 Fed. Reg. at 54332-54333.</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">In sum, CMS is proposing to define the term "reasonable and necessary" based on the factors currently found in the MPIM, plus an alternative basis for meeting factor (3) based on any coverage in the commercial market. As CMS states, it is soliciting comment on this proposed definition of reasonable and necessary as well as other mechanisms or definitions it could establish for the term "reasonable and necessary" and the merits and drawbacks associated with each, including the potential impact on Medicare program expenses or complexity.</p><h3 style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.3em !important; margin-bottom: 0.5em !important; margin-top: 1.3em !important;">Key Takeaways</h3><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">To be sure, CMS did not propose this regulatory definition in a vacuum. This definition, if finalized, would be codified within 42 C.F.R. Part 405, Subpart B, which addresses "Medical Services Coverage Decisions that Relate to Health Care Technology." In this proposed rule and not discussed in detail here, CMS also seeks national Medicare coverage for breakthrough devices that are FDA market-authorized and used consistent with the FDA approved or cleared indication for use. For these devices, CMS will deem coverage under the MCIT pathway "reasonable and necessary under section 1862(a)(1)(A) of the Act because the device has met the unique criteria of the FDA Breakthrough Devices Program." 85 Fed. Reg. at 54329.</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">What is markedly absent from this proposed regulatory definition is an explicit requirement that this new regulatory definition be used solely for medical devices participating in the MCIT pathway and/or the <a href="https://www.fda.gov/medical-devices/how-study-and-market-your-device/breakthrough-devices-program" style="background-color: transparent; box-sizing: border-box; color: rgb(27, 81, 124) !important; overflow-wrap: break-word; text-decoration-line: none !important;" target="_blank">FDA Breakthrough Devices Program</a>. In fact, CMS explains:</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-left: 40px; margin-top: 0px; overflow-wrap: break-word;">Further, under our proposal, each MAC would be responsible for reviewing commercial offerings to inform their LCDs or claim by claim decisions, which would include individual medical necessity decisions. We may also allow the MACs to develop approaches to address any or all of the considerations outlined above, parallel to their current practice of making coverage decisions in the absence of an NCD or national policy.</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">85 Fed. Reg. at 54332.</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;">While it remains to be seen whether claim adjudicators may utilize this proposed regulatory definition for other services or items outside of the FDA Breakthrough Devices Program or MCIT pathway, this could be useful for individual consideration of Medicare claims since any additional clarification to the subjective "reasonable and necessary" is helpful.</p><p style="background-color: white; box-sizing: border-box; color: #292929; font-family: georgia, serif; font-size: 18px; letter-spacing: 0.2px; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;"><br /></p><p style="background-color: white; box-sizing: border-box; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;"><span style="color: #292929; font-family: georgia, serif;"><span style="font-size: 18px; letter-spacing: 0.2px;"><a href="https://www.jdsupra.com/legalnews/cms-finally-proposes-a-regulatory-16884/" target="_blank">Read more</a></span></span></p><p style="background-color: white; box-sizing: border-box; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;"><br /></p><p style="background-color: white; box-sizing: border-box; line-height: 1.618em !important; margin-bottom: 1em !important; margin-top: 0px; overflow-wrap: break-word;"><span style="color: #292929; font-family: georgia, serif;"><span style="font-size: 18px; letter-spacing: 0.2px;"><br /></span></span></p><div class="blogger-post-footer">www.ermconsultinginc.com</div>MRA Alerts and Updateshttp://www.blogger.com/profile/00059372442260907251noreply@blogger.com1