Category Archives: Risk Adjustment (MRA)
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
CMS Risk Adjustment Data Submission Deadlines and Payment Schedule
The nature of capitation and the risk adjustment payment method requires specific deadlines for data submission that correlate to dates of service and affect capitation payments. The Centers for Medicare and Medicaid Services (CMS) observes the following three deadlines each … Read Full Post
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
This blog was updated for ICD-10-CM. Read it here. 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 … 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