Tag Archives: risk adjustment

A Moment of Silence for the Sunsetting MRA Program – Part 3

This has been a difficult series of articles for our company, summarizing the 2024 changes to the CMS-HCC risk adjustment model.  And we imagine our clients are speechless when considering the financial ramifications to their businesses. If you’ve missed any … Read Full Post

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A Moment of Silence for the Sunsetting MRA Program – Part 2

By now, you may have come to terms that MRA, as we know it, is on its way out. If you’re not informed about the changes for 2024, we urge you to read the first installment of this article series.  … Read Full Post

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A Moment of Silence for the Sunsetting MRA Program – Part 1

Since the CMS-HCC risk adjustment payment paradigm took effect in 2003, our company has seen considerable changes, but this year takes the cake, as they say.  Frankly, a moment (or really, a week) of silence would be appropriate to mourn … Read Full Post

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MRA & FFS Normalization

This post is parenthetical to the series entitled, A Moment of Silence for the Sunsetting MRA Program. Although Medicare Advantage (MA) and the traditional Medicare program cover the same patients (called members in the former and beneficiaries in the latter), … Read Full Post

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Medical Practice Owes for COPD & Morbid Obesity False Claims

Over the years, we’ve written many a blog post on risk adjustment compliance, advising our readers on ways to work successfully with this payment paradigm.  And yet, almost every week, the Office of Inspector General (OIG) publishes notices regarding false … Read Full Post

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“Removals” is not a bad word!

“You are leaving money on the table” is a common phrase Medicare Advantage providers hear from some auditors and even health plans regarding members’ risk scores. And that might be true. Some risk adjusted diagnoses may have fallen through the … Read Full Post

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What We’re Reading – DOJ Launches Lawsuit Against Anthem for Risk Adjustment Fraud

As detailed in this article, Anthem is facing a lawsuit initiated by the Department of Justice (DOJ) for allegedly failing to remove erroneously submitted diagnoses from CMS’s database despite knowing that inconsistencies might be present. The health insurance carrier commissioned … Read Full Post

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Telehealth & MRA

There is much miscommunication regarding the use of telehealth services to report risk adjusted diagnoses.  In the early days of COVID-19, CMS stated that it would pay for telehealth services that were conducted in an interactive format using both audio … 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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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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