Tag Archives: risk adjusted payment

Hidden MRA Treasure – Part 2

In Part 1 of this series, we reviewed ICD-10-CM code I77.1 and explained that there are some often overlooked conditions that increase your risk adjusted payments. This time, we’ll focus on ICD-10-CM code J84.10, Pulmonary fibrosis, unspecified. This code was … Read Full Post

Tagged granuloma of lung, J84.10, pulmonary fibrosis, risk adjusted payment |

Hidden MRA Treasure – Part 1

In the early days of the CMS-HCC model, providers were not versed at all on the inner workings of the risk adjusted payment paradigm or the conditions included. And admittedly, much has changed in these 18 years. Most providers know … Read Full Post

Tagged carotid stenosis, I77.1, risk adjusted payment, stricture, tortuous artery |

Kaiser Permanente: Most Recent to Fall Under DOJ Scrutiny

Kaiser Permanente is the latest Medicare Advantage (MA) plan to be embroiled in allegations of False Claims Act violations for risk adjusted coding activities. As you might recall, Humana was flagged for reporting unsupported risk adjusted diagnoses, Anthem allegedly failed … Read Full Post

Tagged addendum, assessment, mra, risk adjusted payment |

MRA Issues from the Trenches

We have blogged quite extensively on all things MRA and especially the need for solid documentation. Historically, a provider’s charting improves when the spotlight is shined on it, but old habits are hard to break; we find that, sadly, documentation … Read Full Post

Tagged assessment, cancer, combination codes, lab-based conditions, risk adjusted payment |

OIG Finds Errors in Humana Compliance Audit

When the Centers for Medicare and Medicaid Services (CMS) risk adjustment data validation (RADV) audit identified coding errors for one Humana contract representing members in South Florida, the Office of Inspector General (OIG) conducted its own audit. We should recall … Read Full Post

Tagged Humana, mra, OIG, risk adjusted payment |

Billing No-Nos: Having the Billing Dept. Transact MA Encounters

Medicare Advantage (MA) plans are paid by the Centers for Medicare and Medicaid Services (CMS) based on the member’s severity of illness as conveyed by codes from the International Classification of Diseases, 10th Revision or ICD-10-CM that map to the … Read Full Post

Tagged FFS, medical billing, medicare advantage, risk adjusted payment |