Monthly Archives: "March, 2015"

Renal Transplantation

PACE programs don’t often face the possibility of a participant receiving a renal transplant. However, most Executive Directors and Medical Directors worry that, should that situation arise, that the cost would be prohibitive and that their program could never absorb the financial burden. Fortunately, that is not the case.

Your dialysis participants don’t use the Version 21 HCC model that is used to calculate risk scores for your other participants. Instead they…

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Annual Verification of Parent Organization and Legal Entity Name

On February 27th CMS released a memo called “Annual Verification of Parent Organization and Legal Entity Name”. This memo requested Plans to review the accuracy of their company’s parent organization and legal entity name in the Health Plan Management System (HPMS). The memo requested Plans to report any necessary corrections by March 16th.

For PACE plans a change in the Parent organization or legal name is fairly infrequent. However, this memo should serve as a compliance reminder to maintain…

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Documenting and coding: Depression vs. Major depression

When documenting depression, it is important to document completely and accurately in order for the most appropriate and specific code to be assigned.   The correct diagnosis and ICD-9 code may be the difference between a diagnosis that maps to an HCC and one that does not.  For example, ICD-9 code 311 (depressive disorder, NEC) does not map to an HCC, but 296.XX (major depression) maps to HCC 58.

There are not DSM IV criteria for “depression” and “major” depression; only…

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Progress Notes: CMS Compliance for Data Management

As we mentioned in previous missives, compliance with CMS regulations for data management is a big theme this year.  CMS provided two HPMS memos recently that are relevant to PACE organizations that wish to demonstrate compliance in an important way.  The first memo on Feb 18 refers to the requirement for PACE Organizations to return overpayments to CMS in a timely fashion (defined by the Affordable Care Act as within 60 days after the overpayment is identified).

Most overpayments are…

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