The Provider’s Role in Risk Adjustment Coding
Physicians must code diagnoses properly to succeed under Medicare & other value-based contracts Each year, CMS sets cost benchmarks for every Medicare member, based on the patients’ diagnoses during the prior year. But what if the physician hasn’t reported their patients’ health information accurately or fully? The result is often benchmarks that are set too […]
Getting Paid for Transitional Care Management (TCM)
Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to provide TCM services after beneficiaries were discharged to the community from medical facilities. As a result, Medicare spending on TCM services increased over 200 percent between 2013 and 2016, and studies show that these services significantly reduced cost and mortality in […]
Medicare Advantage Star Rating and the Provider: Rewarding, Complex and Competitive
CMS created the Star Ratings system in 2008 to help seniors compare quality and performance among Medicare Advantage (MA) Part C plans and Part D prescription drug plans (PDPs). Insurance companies also benefit, as a plan’s star rating influences patients and directly affects membership growth. In 2012, CMS upped the ante by linking premiums and […]
