Category Archives: Risk Adjustment (MRA)
How are Depression and Major Depression Different?
According to Barron’s Medical guide Dictionary of Medical Terms, Fifth Edition by Mike A. Rothenberg, M.D., and Charles F. Chapman, depression (ICD-9-CM code 311) is a dejected state of mind with feelings of sadness, discouragement, and hopelessness, often accompanied by … Read Full Post
Coding Cancers: A Common Charting Error
One of the most common provider charting errors occurs in the area of cancer diagnoses. Practitioners routinely document and code cancers when the patient’s disease has been treated and is no longer evident. For risk adjusted practices, this means the … Read Full Post
What We’re Reading – Medicare Pilot Project for Electronic Submission of Medical Documentation
CMS is launching the Electronic Submission of Medical Documentation (esMD) pilot project for providers to submit medical documentation in electronic fashion when responding to requests from Recovery Audit Contractors. The new system is expected “to reduce provider costs and cycle … Read Full Post
Documenting Manifestations: “Connect” with an Accurate Payment
Over the years, we’ve seen it all when it comes to physician documentation. One physician in a group insisted that if she wrote all the conditions on one line, they were connected. Her partner’s charting habit was using slash marks … Read Full Post
Alcohol Abuse vs. Dependence: Is it Fraudulent to Knowingly Soft-Pedal a Diagnosis?
Do you think a provider would chart heart disease for a patient with – say – hypertrophic cardiomyopathy because it’s a ‘warmer, fuzzier’ diagnosis? Or try to scare a patient with metabolic disorder into losing weight by diagnosing her prematurely … Read Full Post
The Top Three MRA Mistakes: How much are these costing your practice?
When a medical group’s risk score is low despite a chronically ill patient population, the culprit is generally one of three very common practitioner habits. Let’s explore each one: Failure to connect diabetic manifestations: This is probably the low-hanging fruit … Read Full Post
Why should I use a Consultant?
Question: Why should I use a Consultant? Answer: The dictionary defines a consultant as a person referred to for expert or professional advice. At Coleman Consulting Group, we believe that using a consultant can be the best of both worlds: … Read Full Post
Why is my Risk Score so low when my patients are so sick?
A risk score is a numeric representation of the health status of your patients based on factors developed by the Centers for Medicare and Medicaid Services (CMS). Each patient has a risk score and your practice has one too. The … Read Full Post
How does provider reimbursement work?
There are two common methods of reimbursing physicians: Fee-for- service (FFS) and capitation. There are also two major code categories in use by most primary care physicians: ICD-9-CM codes and CPT-4 & HCPCS codes. ICD-9-CM codes (soon to be replaced … Read Full Post
Capitation
The simplest definition of capitation is a per-member, per month (PMPM) payment based on a defined population of enrolled members; the payment has nothing to do with the level or amount of care given to the patient. In fact, when … Read Full Post