12 articles matching “hcc”.
Showing 1 to 12 of 12
Population health billing covers chronic care management codes 99490-99491 and 99439-99437 with consent and time documentation requirements, transitional care management 99495-99496 post-discharge 2-business-day contact and face-to-face...
Medicare Advantage billing differs fundamentally from traditional Medicare: MA plans have their own fee schedules, prior authorization requirements for services traditional Medicare never requires PA for, HCC risk adjustment coding requi...
ACO Medicare Shared Savings Program mechanics including risk-adjusted benchmarking and attribution, BPCI-A bundled payment episode cost management and target price risk adjustment, MIPS four-category performance scoring and payment adjus...
CDI program structure with concurrent and retrospective review, compliant physician query types and non-leading query methodology, DRG CC/MCC documentation for inpatient reimbursement optimization, HCC risk adjustment CDI for Medicare Ad...
First-listed diagnosis selection rules, coding uncertain diagnoses as signs and symptoms in outpatient settings, chronic condition coding at every applicable visit, Z code applications for preventive and screening encounters, and ICD-10-...
CCM and TCM billing documentation requirements, AWV as a quality measure and HCC capture vehicle, MIPS CPT II quality measure coding, ACO patient attribution and cost-of-care documentation, and behavioral health integration (BHI) codes.
How the CMS-HCC model calculates RAF scores, high-value HCC coefficients, AWV-based annual HCC capture workflow, ICD-10 coding specificity for diabetes and CKD risk adjustment, and RADV audit compliance requirements.
How RAF scores are calculated, how HCC coding drives them, the revenue impact of RAF gaps, and how to build a compliant annual recapture program.
Capture every legitimate HCC condition with documentation precision and coding specificity that stands up to RADV audit scrutiny.
Systematic approaches to improving RAF accuracy, from gap closure programs to chart retrieval and HCC recapture workflows.
Everything health plan teams need to know about HCC coding, RAF scores, compliance requirements, and optimization programs.
A structured approach to identifying and closing HCC coding gaps before they cost your plan in CMS reconciliation.
