Tag Archives: risk adjustment

What We’re Reading – GAO recommends ending CMS bonus payment demonstration

From the GAO.gov website and different healthcare news websites. The Government Accountability Office (GAO), a nonpartisan investigative arm of Congress, recommends that CMS should discontinue its quality bonus program demonstration. The reasons are the budgetary impact, lack of data to … Read Full Post

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HEDIS: Is Yours a Five-Star Health Plan?

To most patients, quality is amorphous; we know it when we see it. To a healthcare administrator, however, quality has a whole other meaning. It’s measurable, measured and a measure of the congruence of several factors.  In managed care, quality … Read Full Post

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What does it mean to be “at risk?”

The concept of being “at risk” has to do with the level of financial risk the entity has in funding the care its patients receive.   As profit-oriented enterprises, insurance companies generally assess the insured’s risk and base the premium on … Read Full Post

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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

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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

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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

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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

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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

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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

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What is MRA?

MRA – Medicare Risk Adjustment – was established in 2003 and phased in over a five year period. Through this payment methodology, the MedicareAdvantage Plan’s (and the provider’s) capitation is adjusted based on the risk assumed for the patient’s care, … Read Full Post

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