Thursday, June 22, 2017

Book Your Onsite Risk Adjustment Workshop Today!

Train your entire team onsite with our 1/2 day, 1 day and 2 day workshops!                
  • AAPC CEUs available for your coders, CDI specialists, compliance team and auditors.
  • AAFP and AMA CME available for all physician training.

 2017 dates are filling up quick!

  • Intro to Risk Adjustment
  • Advanced Risk Management for Value Based Care
  • Intro to HCC Coding
  • Advanced HCC Coding
  • CDI for Risk Adjustment
  • Risk Adjustment Validation
  • Rapid Practice Innovation (TCPI)
      Half-day Workshops start at $3500
      One-day and Two-day Workshops start at $5000

      Visit ERM Consulting to learn more or email Kameron Gifford



Tuesday, June 13, 2017

How Can We Improve?

Are you looking for the very best in risk adjustment education?

If so, join us in Orlando, Florida on July 21, 2017 for a day of risk adjustment, clinical documentation improvement and HCC coding.

Why Should I Come?

  • CME / CEU available from AAPC, AMA and AAFP

  • Network with plan leaders, managed care executives, medical directors, primary care physicians, fiancĂ© leaders and coders from across the country.

  • Have your toughest questions answered by risk adjustment experts.

  • Best of all, you will take home great tools!

             Bring the whole team and save 20% on 3 or more


  • Review the different risk adjustment models and their impact on medical practice management.

  • Discuss the impact of shifting from RAPS to EDS. What does this mean for office based claims.

  • Take a deep dive into HCC Coding and Documentation. Review real examples to see what validates, what doesn’t, and why.

  • Avoid risk adjustment pitfalls. Recent litigation relating to false risk adjustment certifications and  overpayments.

  • Tips for engaging physicians.Learn how to leverage frontline staff to be successful in the world of risk adjustment and value based payments.

Who Should Attend:

  • Managed Care Executives

  • Physicians / Medical Directors

  • ACOs, MSOs, IPAs and Health Alliance Members

  • CMS TCPI Participants

  • Value Based Care Organization

  • Medicare Advantage, Commercial and Medicaid Plans

  • Rural Health Centers and FQHCs


Each Attendee will Receive:

  • Clinical Documentation and Coding Guide $ 99 Value

  • HCC Quick Coder (Mappings to ICD-10 Codes) for MA and Commercial Models

  • Risk Adjustment Workbook and Appendix with Easy to Use Templates

  • Laminated Coding and Documentation Tools

Call to 407-964-7165 between 8:30am and 5:00pm,
Monday through Friday to book your room.

For More Events Visit ERM Consulting

AAPC CEU and AAFP CME Available!

This Live activity, Advanced Risk Management and CDI for Primary Care, from 07/21/2017 - 07/01/2018, has been reviewed and is acceptable for up to 5.75 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

AMA/AAFP Equivalency:

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

Saturday, June 10, 2017

The Centers for Medicare & Medicaid Services (CMS) announced predictive Qualifying APM Participant (QP) status for 2017 Advanced APMs.

Predictive Qualifying APM Participants

The Centers for Medicare & Medicaid Services (CMS) announced predictive Qualifying APM Participant (QP) status for 2017 Advanced APMs. By looking at historical Part B claims data, CMS predicts that nearly 100% of eligible clinicians in Advanced APMs with data currently available will be QPs in performance year 2017.
Click on the links for additional Information:

What is the Predictive QP status analysis?

One of the Quality Payment Program’s goals is to be clear about your Qualifying APM Participant (QP) or Partial QP status. 

For the 2017 Predictive QP analysis, this is how CMS determined if you, from your participation in one of the following Advanced APMs, are predicted to be a QP for the 2017 performance year and are likely to be eligible for the 5% APM Incentive Payment in the 2019 payment year. These calculations are predictive in nature, meaning they are a prediction of your QP status in performance year 2017, if you participate in at least one of these Advanced APMs in performance year 2017:
  • Comprehensive ESRD Care (CEC) -Two-Sided Risk
  • Comprehensive Primary Care Plus (CPC+)
  • Next Generation Accountable Care Organization (ACO) Model
  • Medicare Shared Savings Program -Track 2
  • Medicare Shared Savings Program -Track 3
For this analysis, CMS used administrative claims with dates of service between 1/1/16 and 8/31/16 that were processed between 1/1/16 and 11/30/16. Actual QP determinations will use claims data from the relevant performance year as of three points in time, or “snapshot” dates: March 31, June 30, and August 31.

If you are a participant in the Comprehensive Care for Joint Replacement Model (CJR)—CEHRT Track, CMS did not make predictions about your QP status for performance year 2017. The CJR-CEHRT Track did not begin until 2017 so there are no historical claims data available.

In addition, CMS did not make predictions for the Oncology Care Model (OCM)—Two-Sided Risk Arrangement as there are no OCM practices currently participating in this arrangement.

What were the Predictive QP & Partial QP determination steps?

CMS took the following steps to estimate QPs and Partial QPs in our 2017 predictive analysis.
  1. Identified eligible clinicians participating in Advanced APMs using the APM Entity participation lists.
  2. Identified attribution-eligible beneficiaries from Medicare Parts A and B administrative claims data and Medicare beneficiary enrollment information.
  3. Identified beneficiaries attributed to Advanced APM Entities.
  4. Calculated payment amount Threshold Scores.
  5. Calculated patient count Threshold Score.
  6. Determined predictive QP or Partial QP status for an APM Entity group based on the payment amount or patient count. We applied the more advantageous QP Status to the eligible clinicians participating in the APM Entity.
How did CMS identify attribution-eligible beneficiaries?

CMS found beneficiaries to be attribution-eligible to an APM Entity if during the historical assessment period they:
  • Weren't enrolled in Medicare Advantage or a Medicare Cost Plan.
  • Didn't have Medicare as a second payer.
  • Were enrolled in both parts A and B for the entire QP performance period.
  • Were at least 18 years of age on January 1.
  • Were a United States resident.
  • Had at least one claim for E/M services furnished by one or a group of eligible clinicians used in assignment in an APM Entity during the historical assessment period.
To match the attribution eligibility criteria with each APM’s attribution methodology, we may apply exceptions to the evaluation and management requirement for attribution-eligible beneficiaries. Such an exception will be applied in 2017 to the CEC model, including the predictive QP analysis.

Download the Fact Sheet to Read More

CMS Is Accepting Future Measures and Activities for Three MIPS Performance Categories

CMS' Annual Call for Measures and Activities for the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP) is accepting Quality and Advancing Care Information measure proposals through June 30, 2017 for the 2018 program year; measures submitted beginning July 1, 2017 will be considered for the 2019 program year.
CMS encourages clinicians, measure stewards, organizations, and other stakeholders to identify and submit measures and activities to be considered for the Quality, Advancing Care Information, and Improvement Activities performance categories of MIPS in future years.

Submission Details
Measures and activities should be relevant, reliable, and valid at the individual clinician level. To be considered, proposals must include measure specifications, related research, and background.
A final list of measures and activities for MIPS clinicians will be published in the Federal Register no later than November 1 of the year prior to the first day of the performance period. Please note that some Advancing Care Information measures finalized in the 2018 final rule may not take effect until 2020, depending on the functionalities and workflow changes needed for implementation.
For More Information
Remember to review the Annual Call for Measures and Activities fact sheet to learn more and understand the process for submitting measures for the MIPS performance categories. Please direct any questions on measure and activity submissions to the QPP Service Center at