Wednesday, December 27, 2017

Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for the Medicare Advantage (MA) CMS-HCC Risk Adjustment Model

The Centers for Medicare & Medicaid Services (CMS) released Part I of the 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies (the Advance Notice), on December 27, 2017, which contains key information about proposed updates to the Part C Risk Adjustment Model and the use of encounter data.

The following HCC Categories were proposed:
  1. Drug Abuse, Uncomplicated, Except Cannabis (HCC 56)
  2. Reactive and Unspecified Psychosis (HCC 58 - the current HCC 58 will be renumbered as HCC 59)
  3. Personality Disorders (HCC 60)
  4. CKD Moderate, Stage 3 (HCC 138)

CMS also proposed the following changes to the CMS-HCC Risk Adjustment model

  1. Add selected drug and alcohol “poisoning” (overdose) codes to existing “Drug/Alcohol Dependence,” to create “Drug/Alcohol Dependence, or Abuse/Use with Complications” (HCC 55). 
  2. Add new factors to the six community and single long term institutional (LTI) segments that take into account a beneficiary’s number of conditions that are in the payment model.

Part II was released on February 1, 2018

Thursday, December 21, 2017

Give the Gift of Knowledge this Holiday Season!

    Register your team today - Orlando is SOLD OUT!

   Join Us for a Day of Risk Adjustment! 

  • 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 clinical documentation. Review real examples to see what validates, what doesn’t, and why. Tips for engaging physicians.
  • Learn how to leverage frontline staff to be successful in the world of risk adjustment and value based payments.  

     Each Attendee Will Receive:     ($130+ value)

  • Color Presentation
  • Clinical Documentation and Coding Guide
  • HCC Quick Coder
  • Laminated Coding and Documentation Tools

     Who Should Attend: 
  • Medical Coders and Billers
  • Providers, Managers and Frontline Staff
  • CDI Specialists
  • Executive Leaders
  • ACO, MSO and IPA Teams
  • Rural Health Centers
  • Health Alliance Members
  • Medicare, Medicaid and Commercial Plans

      Thursday January 25th 2018
      10:00 AM - 4:00 PM

        Symphony Presentation Center 
        2875 S Ocean Blvd, Suite 200, Palm Beach, FL 33480

      Thursday, April 5th, 2018
      10:00 AM - 4:00 PM
        Hilton Garden Inn Tampa / Riverview
        4328 Garden Vista Dr., Riverview, FL 33578


    View additional details and download the complete agenda here