Coding and Documentation Takes Center Stage

RISE members are hungry for insights and guidance about coding in this world of risk adjusted health insurance.  In particular, the coders are asking for opportunities to learn from those who have a grasp on deciperhing the complex and specific interpretations of ICD coding.  At the abstract level, it is rather simply and straight-forward.  But in the specific situations of real world charting, not so much. There are weighty concerns about legal and compliance implications, as well.  That is what makes the cheese binding, as my father used to say.  The charts are the unalterable source of truth, which is not in dispute.  But how do you put all the pieces of the chart together to support a diagnosis?  And how would a CMS auditor come down on your decision in a RADV audit?  

RISE is very interested in making sure we all do the right thing.  We want to be sure that everyone is highly compliant.  We also want to ensure that the risk adjustments that are derived from the diagnoses accurately compensate the MAO for the prospective healthcare risks.  

The first step is a workshop that we are putting on in Coral Gables on November 17th, which should provide a lot of input into the discussion about what the right thing looks like in practice.  

I hope to see you there, but if you cannot join us, please join the conversation.  We want to hear from you.  What are the toughest situations you run into?  Where are the key points of deciding how to decide what code to capture and report?  Are there "bright lines" you recommend?  

Make your voice heard! Send me your thoughts and suggestions:

Kevin Mowll 

kmowll@risehealth.org

 

 


Log on to Your Rise Account

Forgot your password?
Create an Account

Sponsors

Latest Posts

CMS Gives EDPS Transition Some Breathing Room

CMS published the final call letter for 2018 yesterday, April 3, which included a welcome accouncement regarding the transition from RAPS to EDPS-based RAF scores. Citing numerous public comments on the subject, CMS throttled back the speed with which they plan to switch over to an encounter-based methodology. Instead of the blended rates originally contemplated, they announced that the more modest blend of 85% RAPS to 15% EDPS would be used in 2018, allowing more time to improve the reliability of the encounter data methods. While the RISE data collaboration study was not cited, we believe that the educational value of our study, along with our communication and advocacy of a more moderate approach by CMS, contributed to the confidence with which plans and other interested parties spoke up during the open comment period. Once again, we owe thanks to the folks at Avalere and Inovalon, as well as at AHIP, for the collegial and professional collaboration. Also, we want to thank the health plans that actively participated in our study for making this work possible. ...
Read More

Take Aways from RISE Nashville Summit

The 11th Annual RISE Nashville Summit continued the event’s tradition of yearly growth. The return to downtown Nashville was widely applauded by attendees, who were glad to be back near Broadway’s nighttime funk and fun. While festive, this year's event occurred in the wake of the new administration in Washington, D.C., and the healthcare themes surrounding the "repeal and replace" of the Affordable Care Act (ACA) cast a long shadow. In contrast to the upbeat, confident notes struck by last year’s keynote speaker Senator Tom Daschle, this year’s sobering keynote address by Howard Fineman, NBC/MSNBC political analyst, The Huffington Post Media Group global editorial director, and bestselling author, was an assessment of the pluses and minuses of our new president. Mr. Fineman's remarks indicated that the political alliances in power will seek to undo what Senator Daschle viewed as "irreversible” a year ago....
Read More

Upcoming Conference

 

Qualipalooza: The 2nd Annual RISE Quality Leadership Summit 

This unique event incorporates three conferences presented side-by-side: the Star Ratings Strategic Planning Forum, the HEDIS Forum, and the CAHPS, HOS & Member Survey Forum. Register for one conference for an in-depth examination of a single area, or design your own event by opting for the all-access pass and choosing the sessions from each conference which correspond exactly to your interests.

More

Upcoming Webinar

The Impact of Quality Incentive Models in Medicaid Markets

 

Thirty-one of our fifty states now have Medicaid managed care, and several markets are expected to implement managed care in the next few years. More than $160B in Medicaid spending occurs through the Managed Care Organizations. As more and more states seek to do more with less, increasing accountability for health quality outcomes is placed on health plans. Join this webinar to learn the typical quality payment approaches states use, issues often faced by health plans under each model and what states are expected to do with payment models tied to quality performance in light of near term Medicaid reform efforts.

More

Connect With Us

Copyright © 2014 Resource Initiative & Society for Education. All rights reserved.