Tag Archives: risk adjustment

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

Tagged center for medicare and medicaid services, colorectal cancer screening, health plans, hedis, henry j kaiser family foundation, medical providers, medicare advantage plans, mra, risk adjustment |

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

Tagged capitation payments, cms, independent practice associations, management services organization, medicare risk adjustment, medicareadvantage plans, mra, risk, risk adjustment |

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

Tagged cancer diagnoses, capitation, charting errors, coding cancer, documentation, medicare risk adjustment, practice's reimbursement, risk adjusted practices, risk adjustment |

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

Tagged diabetes, documentation, electronic health record, manifestations, physician documentation, reimbursement, risk adjustment |

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

Tagged addiction, alcohol abuse, alcohol dependence, diagnosis, fraud, medicare, risk adjustment, soft-pedaling |

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

Tagged cardiac disease, diabetic, icd-9, improper documentation, medical practice, medicare, practitioner, risk adjustment |

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

Tagged consultants, healthcare consultants, home health, home health agency, mra, risk adjustment |

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

Tagged cms, diagnoses, icd-9, medicaid, medicare, patients, risk adjustment, risk score |

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

Tagged chronic care, diagnosis, icd-9, medicare, mra, patient, payment, provider, risk adjustment |