When I talk with friends, family and business acquaintances universally they answer yes to one or more of these questions, with emotional responses about what it is like to interact with the healthcare system in the United States. Often, they feel the doctors, nurses, and hospitals (the providers) have done a good job. The business …
Life, Liberty and the Pursuit of Happiness, Without Healthcare!
The 2018 Open Enrollment Period to purchase healthcare insurance under the Affordable Care Act (ACA) runs from November 1, 2017 to December 15, 2017. This is a month and a half less time than was given to sign up in 2016 for 2017 coverage. If you are: Self-employed Work for a company that does not offer …
Hierarchal Condition Categories (HCC) and Managed Care
HCC and the associated codes are currently an obscure sidebar that pass under the radar of all except practices that accept risk for Medicare Advantage patients. Healthcare charting, billing and reporting have long been a mind-numbing alphabet soup of acronyms and numbers. As practices make the transition from fee-for-service (FFS) reimbursement models to outcome-based reimbursement, …
Getting Paid for What You Do- A Capitation Evolution
Anyone that worked in the industry or had an HMO plan in the 1980s and early ‘90s likely has bad memories of capitated payment plans. These insurance plans, among other things, provided a fixed amount of money for a provider to care for a patient in any contract year.
RAF & HCC
Simple facts related to Medicare Risk Adjustment Factors (RAF) and the Hierarchical Condition Category (HCC) model Enrollment in Medicare Advantage has increased from 11.1 million patients in 2010 to 14.4 million in 2013 25 percent(25%)of all Medicare beneficiaries are enrolled in Advantage programs In 2010 2/3 of all Medicare beneficiaries had multiple chronic conditions; 14% …
PQRS Update
Update on PQRS Program – April 2014 The CMS website is a great source of information – but it can be almost too much information. We have pulled forward here some important highlights and tidbits along with highlighting some of the ways the REVEALware™ tool can help.
Avoid PQRS Penalties
On April 16, 2013, CMS made some significant clarifications regarding PQRS. CMS is clearly working to align the quality measures from different programs and to assist practices in avoiding penalties.
Seven Steps to Stark and Meaningful Use
The combination of Meaningful Use and other related compliance requirements and Stark Safe Harbor creates a “Perfect Storm” to put the creation of that strategy in the hands of hospital CIO’s. Quite frankly I’m a bit surprised more IT organizations are not proposing this concept to their executive boards as a method of achieving a competitive advantage. For any hospital already providing EHR technology to their own ambulatory physicians, the incremental effort is minimal compared to the potential benefits. Of course it is important to have an explicit strategy, and to operationalize the concept, but the tasks should be within the reach of most acute hospitals, and possibly even some Critical Access Hospitals affiliated with physician practices.