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, …

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Medicare Education

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% …

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PQRS Update

Policy 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.

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Avoid PQRS Penalties

pqrs deadlines

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.

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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.

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