KNOWLEDGE & INSIGHTS

In early 2003, the Centers for Medicare and Medicaid Services (CMS) announced the adoption of a new Hierarchical Condition Category (HCC) risk model. Encounters with dates of service up to December 31, 2022 were subject to risk score calculation based on Version 24 (V24) of the CMS-HCC model. Risk scores for encounters with dates of service on or after January 1, 2023 are now, in part, subject to calculation based on the new version (V28). Given the significant change in goin

In the ever-evolving healthcare landscape, accurate documentation and coding are pivotal in ensuring quality care, appropriate reimbursement, and successful risk adjustment. Let’s delve into why these aspects are crucial for providers and payers. Risk adjustment is the process of accounting for the health status of patients when determining payment. It aims to level the playing field by adjusting reimbursement based on the severity of illness. Here’s why documentation and cod

Until recently, the Office of the Inspector General (OIG) and the Department of Justice (DOJ) were seldom mentioned in news concerning documentation, coding, and risk adjustment. However, a recent surge in news coverage reveals a notable uptick in the engagement of these governmental bodies in matters of risk adjustment, whether conducted by Medicare Advantage health plans, risk adjustment vendors, or healthcare providers. Aside from the increased scrutiny of OIG and legal ac