Monthly Archives: "June, 2015"

PACE is Now Included in the Medicare Plan Finder

On June 24th CMS issued a memo regarding the inclusion of PACE in the 2016 Medicare Plan Finder website and the ‘Medicare & You’ handbook.

This memo urgently requests plan users to validate the accuracy of specific contact data in the Health Plan Management System (HPMS). The primary fields to review/update are in the memo and this data will be used by CMS to update the website and handbook. This is a tremendous marketing opportunity not previously afforded to…

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Documenting COPD & Asthma

COPD is a condition that is often times incorrectly documented.   COPD can be referred to as an irreversible airway obstruction associated with chronic bronchitis and/or emphysema.  Asthma is defined as a reversible airway obstruction, which means it can be treated to remove the airway obstruction.

If COPD (496) is documented by itself, the coder can justly assign code 496.  Asthma documented by itself would be assigned ICD-9 code 493.90.   However, when COPD (496) and asthma (493.90) are documented together, careful…

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Value Based Healthcare

For several years, but especially over the past year, we have heard increasing discussions and commentary about the evolution of American healthcare toward the  concept of value.  Value is defined in several ways, but commonly is understood in terms of outcomes relative to costs.  Simply reducing costs without attention to outcomes is risky and may not produce desired results.  CMS has promoted the well-known “triple aim” with three value vectors of patient…

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Risk Adjustment Attestation Due this month

On June 1st CMS issued a memo titled “Payment Year 2014 Risk Adjustment Attestation.” This memo reaffirms the plan requirement to complete an annual attestation of risk adjustment data. The attestation is for payment year 2014, so plans will be attesting to the accuracy of the data submitted with a 2013 date of service, which made up payment year 2014. The attestation is…

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