2022 HCC Risk Adjustment Tools for Physicians and Coders

 

Is Your Team Risk Ready?

Arm Your Team For Combat This Risk Adjustment Season!

Prepare for Victory...

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?

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.

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!

Learn more - https://erm.ecwid.com/

ORDER TODAY - THESE WILL GO FAST!!

CMS-HCC Coding Cards

https://erm.ecwid.com/2022-CMS-HCC-Coding-Cards-12-Pack-p432478501

You will love these 5x7 HCC Coding Cards!

Updated for 2022 - Version 24

This 14 pack is perfect your next risk adjustment project.

1.Diabetes:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

2.COPD:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

3.Heart Failure:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

4.Major Depressive Disorder:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

5.Malnutrition and Morbid Obesity:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

6.Complications with Internal Devices and Dependence:

•ICD-10 Coding Tips for Complications (side 1) includes RAF

•ICD-10 Coding Tips for Dependency(side 2) includes RAF

7. Infectious Disease:

•ICD-10 CDI / Coding Tips for HIV and Sepsis (side 1) includes RAF

•ICD-10 Coding Tips for Liver Disease (side 2) includes RAF

8. Heart Failure:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

9. Chronic Kidney Disease:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

10. Seizures and Neurological Disorders:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

11. Diseases of the Digestive System:

•ICD-10 ICD-10 Coding Tips (side 1) includes RAF

•ICD-10 ICD-10 Coding Tips (side 2) includes RAF

12. Primary and Secondary Neoplasms:

•ICD-10 ICD-10 Coding Tips (side 1) includes RAF

•ICD-10 ICD-10 Coding Tips (side 2) includes RAF

13. Coagulation Defects:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

14. Disorders of Immunity

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

Post one to your bulletin board, stick one near the EHR or tape it to your workstation!

HCC Coding Cards are made to last all year on thick 16 pt cardstock with a gloss finish.

Order for your team today!

CMS-HCC Quick Coders

https://erm.ecwid.com/2022-CMS-HCC-Quick-Coder-p432456253

Completely updated for 2022 - Version 24

This 42 page guide contains everything you need to calculate a risk score in one place!

Includes of the most common HCC codes in the Medicare (CMS-HCC) model.

This guide was designed for providers, with codes sorted alphabetically rather than by code.

Order one for the entire team today!

Includes:

• List of ICD-10 Guidelines
• 270 ICD-10 Codes (Rx and HCCs)
• Quality CPT II codes for MIPS / MACRA
• All CMS-HCC Risk Factors (includes demographic, disease and interaction)
• Trump Chart

Learn more / order here - https://erm.ecwid.com/

2022 CMS-HCC Risk Adjustment Tools

 

Is Your Team Risk Ready?

Arm Your Team For Combat This Risk Adjustment Season!

Prepare for Victory...

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?

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.

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!

Learn more - https://erm.ecwid.com/

ORDER TODAY - THESE WILL GO FAST!!

CMS-HCC Coding Cards

You will love these 5x7 HCC Coding Cards!

Updated for 2022 - Version 24

This 14 pack is perfect your next risk adjustment project.

1.Diabetes:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

2.COPD:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

3.Heart Failure:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

4.Major Depressive Disorder:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

5.Malnutrition and Morbid Obesity:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

6.Complications with Internal Devices and Dependence:

•ICD-10 Coding Tips for Complications (side 1) includes RAF

•ICD-10 Coding Tips for Dependency(side 2) includes RAF

7. Infectious Disease:

•ICD-10 CDI / Coding Tips for HIV and Sepsis (side 1) includes RAF

•ICD-10 Coding Tips for Liver Disease (side 2) includes RAF

8. Heart Failure:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

9. Chronic Kidney Disease:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

10. Seizures and Neurological Disorders:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

11. Diseases of the Digestive System:

•ICD-10 ICD-10 Coding Tips (side 1) includes RAF

•ICD-10 ICD-10 Coding Tips (side 2) includes RAF

12. Primary and Secondary Neoplasms:

•ICD-10 ICD-10 Coding Tips (side 1) includes RAF

•ICD-10 ICD-10 Coding Tips (side 2) includes RAF

13. Coagulation Defects:

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

14. Disorders of Immunity

•ICD-10 Coding Tips (side 1) includes RAF

•Clinical Documentation Tips (side 2) includes RAF

Post one to your bulletin board, stick one near the EHR or tape it to your workstation!

HCC Coding Cards are made to last all year on thick 16 pt cardstock with a gloss finish.

Order for your team today!

CMS-HCC Quick Coders

Completely updated for 2022 - Version 24

This 42 page guide contains everything you need to calculate a risk score in one place!

Includes of the most common HCC codes in the Medicare (CMS-HCC) model.

This guide was designed for providers, with codes sorted alphabetically rather than by code.

Order one for the entire team today!

Includes:

• List of ICD-10 Guidelines
• 270 ICD-10 Codes (Rx and HCCs)
• Quality CPT II codes for MIPS / MACRA
• All CMS-HCC Risk Factors (includes demographic, disease and interaction)
• Trump Chart

Learn more / order here - https://erm.ecwid.com/

Key Litigation and Audits involving Risk Adjustment

If you work in risk adjustment - you should be familiar with these cases. 

• On May 30, 2017, Freedom Health Inc., a Tampa, Florida-based provider of managed care services, and its related corporate entities (collectively “Freedom Health”), agreed to pay $31,695,593 to resolve allegations that they violated the False Claims Act by engaging in illegal schemes to maximize their payment from the government in connection with their Medicare Advantage plans, according to the Justice Department.

• On October 1, 2018, HealthCare Partners Holdings LLC, doing business as DaVita Medical Holdings LLC (DaVita), 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, according to the Justice Department. DaVita is headquartered in El Segundo, California. 

• 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, 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, which resulted in the plans and providers being overpaid.

• 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 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.

• 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”), 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.  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.

• On June 23, 2020, Aveta Inc. and a whistleblower settled a False Claims Act suit alleging that its Medicare Advantage plans collected $1 billion in government overpayments, ending a dispute that served as an early test for litigation involving risk adjustment fraud.  

• 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. Allegations include claims the company submitted unsupported diagnoses that resulted in “billions” in overpayments. Litigation is ongoing - 7:17-cv-07515-KMK-JCM United States of America, EX REL. Robert A. Cutler v. Cigna Corp. et al.

• On November 16, 2020, Kaiser Foundation Health Plan of Washington, formerly known as Group Health Cooperative (GHC), agreed to pay $6,375,000 to resolve allegations that it submitted invalid diagnoses to Medicare for Medicare Advantage beneficiaries and received inflated payments from Medicare as a result, the Justice Department announced.

• On April 19, 2021, the OIG published an audit of diagnosis codes that Humana submitted to CMS for one contract. The OIG recommended 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.

• On July 30, 2021, the United States intervened in six separate False Claims Act (FCA) whistleblower cases alleging Medicare Advantage fraud.  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. 

• On August 30, 2021, the government announced a $90 million False Claims Act settlement 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.

• On September 14, 2021, DOJ filed a Medicare Advantage fraud lawsuit 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)

The BEST Risk Adjustment Education

 

Are you looking for the best education available in risk adjustment, value-based payments and/or CDI? Good News - You have found it!

Join us for a day of risk adjustment and get the BEST risk adjustment education available for $49. 

Do you need CMEs, CEs or CEUs? We have that too!

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.

Register your team (3 or more) today to save 10% on any 2022 Workshops!

Upcoming dates: 

• Saturday, January 22, 2022 https://events.eventzilla.net/e/advanced-risk-management-and-hcc-coding-for-vbp--online-2138830654
• Friday, February 25. 2022 https://events.eventzilla.net/e/advanced-risk-management-and-hcc-coding-for-vbp--online-2138830649
• Friday, March 25, 2022 https://events.eventzilla.net/e/advanced-risk-management-and-hcc-coding-for-vbp--online-2138830648

Learn more / Download the agenda here - www.erm365.org/events

Workshops typically sell out 2 weeks or more before the event. 

Don't wait - register your team today!!

Medicare Risk Adjustment Operations

 

Medicare Risk Adjustment Operations

On-Demand Course Overview:

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.

Success in this market will depend on success in each of the following essential areas:

• Value-based contracting
• Clinical documentation and coding
• Delivering high quality care
• Managing utilization

This course will touch on all four essential areas of MRA Operations.

APPROVED by the AAPC for 5 CEUs - $9.99 until 4/9/2021 and then $19.99

Register here https://erm365.org/courses/medicare-risk-adjustment-operations/

Learn more about ERM365

Let's Talk About Risk

Approved by the AAPC for 3 hours of CEUs

Overview:

This course is a basic introduction to risk adjustment and HCC coding for coders, physicians
and other healthcare professionals. 


Key Objectives Include:

•Learn what an HCC is and what documentation is needed to support it.

•Discover what guidelines impact the CMS-HCC risk adjustment model. 

•Review the components of a risk score and learn how it is calculated. 

•Examine the top 20 HCCs for Medicare beneficiaries per MedPAC data. 

Register for a free account today: www.erm365.org to enroll in the course and start learning.


A link to print your AAPC CEU certificate will be available once you have completed the course. 

Is your organization currently taking on risk or participating in value-based payment models?

If so, we can help! 

ERM Consulting will work with your team to develop an internal risk adjustment program. 

Services Included:

• Remote Auditing and Monitoring - Review of 25 encounters per provider, per month, with detailed monthly reports to track error trends and validation rates. 
• Development of Custom Education - Custom education for providers and coders, every quarter, to reinforce positive changes and educate on new opportunities. 
• Onsite Meetings (One week on-site per Quarter) - 1:1 meetings with providers, coders and leadership to review current audit results and discuss opportunities for improvement. 
• Oversight and Guidance - ERM will provide oversight and guidance to assist with the development of development of internal team and processes needed to manage new payment models. 

Strategic Considerations:

1. Who will be part of the team and what role will they play? 
2. What new processes need to be added or adjusted?
3. How will the team communicate and measure success?

Who is On-boarding, Training and Managing your Coders?

ERM also offers remote on-boarding, training and management of coders and billing teams. 

• Visit ERM online or email for more information.

Contract during the month of December and receive a 25% Discount – on all HCC Coding Tools by ERM – visit our online store at https://erm.ecwid.com/ to see a complete list.

All NEW 2019 Risk Adjustment Workshops

Are you looking for the best education available in risk adjustment, value-based payments and/or CDI?  

Good News - You have found it! Join us for a day of risk adjustment, catch up with colleagues over lunch, and get the best tools in the industry for FREE!

Do you need CMEs or CEUs? We have that too!

All Workshops are approved by the American Medical Association, American Academy of Family Practice and the American Academy of Professional Coders. 

Overview:

What is changing for risk adjustment in 2019? New ICD-10 codes and HCC categories are coming. What should your team be doing now to prepare?

Review the different risk adjustment models and their impact on medical practice management for 2019 and beyond. 

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 documentation examples to see what validates, what doesn’t, and why.  

Learn how to leverage frontline staff to be successful in the world of risk adjustment and value-based payments. 

Download the Agenda Here

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

REGISTER BELOW:

For Jacksonville on 2/21/2019

For Palm Beach Gardens on 3/29/2019

For Ft. Lauderdale on 4/25/2019

For Orlando on 5/15/2019

To SPONSOR an EVENT

Please email Kameron Gifford

Early Bird Pricing and Group Discounts

Register NOW to save $100 with Early Bird Pricing!

Bring the WHOLE TEAM to save 10% on your order!