While the overall concepts of Risk Adjustment (RA) remain the same, January 1, 2024 will bring significant changes to RA and Hierarchical Condition Categories (HCCs). Currently, Medicare Advantage (MA) plans use version 24 (V24) of HCCs, which was released in 2020. Beginning in 2024, a 3-year phased introduction of version 28 (V28) will begin. The… Read More »Changes Coming to Risk Adjustment & Hierarchical Categories
It’s that time of year again. Below you will find a guide for the 2024 ICD-10-CM updates. Topics covered are:
Outpatient Documentation & Coding Issues, September 2023 Presented below is an analysis of new and ongoing initiatives under the Office of the Inspector General (OIG) Work Plan [1] and the Centers for Medicare & Medicaid Services (CMS) approved Recovery Audit Contractor (RAC) reviews [2] as of July 2023. The focus is on outpatient initiatives related… Read More »UASI Compliance Analysis
The WHO ICD-11 classification is very different from the 10th version that the United States modified to create the ICD-10-CM code set that is used for reporting healthcare services on claims in the US today. In monthly code comparisons, we’ve looked at codes that are pre-coordinated or post-coordinated in ICD-11 and compared them with the… Read More »Comparing Codes Across ICD Versions: Spinal stenosis
Make sure you are addressing these top documentation and coding compliance concerns. Risk-based review of evaluation and management codes (E/M): Appropriate application of FY21 E/M code guideline changes Telehealth visits (audio and visual vs. telephone only); Medicaid behavioral health telehealth Review providers with higher than 10% of visits in level 4 and 5, or outliers… Read More »Top 10 Documentation and Coding Issues for Physician Practices in 2021
Make sure you are addressing these top documentation and coding compliance concerns. Risk-based review of inpatient DRG cases, examples include: RAC DRG targets; PEPPER targeted DRGs COVID related inpatient discharges Clinical indicators, cases at risk for clinical denials (e.g. Sepsis, CHF, ARF, severe malnutrition, encephalopathy) IP cases with only 1 MCC/CC code or HAC/PSI cases… Read More »Top 10 Documentation and Coding Issues for Hospitals in 2021
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By: Natalie Sartori, M. Ed., RHIA, CCS This whitepaper is the first in a 2-part series regarding UASI inpatient and outpatient analyses of third party compliance work plans (including the OIG and RACs for example). This document details an analysis of the following active inpatient topics: Medicare Payments for Inpatient Discharges with COVID-19 (OIG) Deep… Read More »UASI Compliance Work Plan Analysis – Inpatient Documentation and Coding Issues
UASI is on the front lines actively working with our clients to help them comply with the biggest change in evaluation and management (E/M) coding since 1997. The new office visit E/M code levels are assigned based on either medical decision making (MDM) or total time. The complex MDM rules make it really easy to… Read More »FY21 E/M Office Visit MDM Part 3: Risk of Complications and/or Morbidity/Mortality
UASI is on the front lines actively working with our clients to help them comply with the biggest change in evaluation and management (E/M) coding since 1997. The new office visit E/M code levels are assigned based on either medical decision making (MDM) or total time. The complex MDM rules make it really easy to… Read More »FY21 E/M Office Visit MDM Part 2: Amount/Complexity of Data Reviewed