Uncategorized

For years, compliance conversations have circled one familiar acronym: MEAT (Monitor, Evaluate, Assess, Treat). It’s a helpful checklist, but it’s not the full story.   If you’re only documenting to hit each MEAT letter, you might be technically compliant, but you’re not necessarily audit-proof. Because at its core, compliant documentation isn’t about ticking boxes, it’s …

Continue reading “Beyond MEAT criteria: What compliant documentation really looks like”

Introduction By 2025, the transition from HCC V24 to V28 will be complete. CMS has already begun a phased transition to the new model, but as we move into Q3, time is running out to prepare for 100% adoption. So what can organizations do to be ready for HCC V28? How can they remain compliant, …

Continue reading “HCC V28: How to Prepare”

HCC (Hierarchical condition category) coding is a complex and ever-changing field, and training clinicians in the traditional seminar format can cause significant pain points for healthcare providers and administrators. Here are just a few examples of the pain points that result from HCC coding education seminars:   Inaccurate or incomplete information: Traditional seminars often result …

Continue reading “Overcoming the costs of bad HCC coding education”

A CMS Medicare Advantage audit is a process used by the Centers for Medicare and Medicaid Services (CMS) to ensure that Medicare Advantage (MA) plans, also known as Medicare Part C, are complying with regulations and standards set by the CMS. The process includes several stages, including notification of the audit, preparation, on-site review, audit …

Continue reading “What to expect during a CMS audit?”

As a healthcare provider, it’s essential to understand the importance of accurate HCC (Hierarchical Condition Category) coding. HCC codes are used to classify patient conditions, which determines  Medicare Advantage payments. Inaccurate HCC coding can have serious consequences for both your practice and your patients.   Inaccurate HCC Coding Impacts Revenue One of the most significant …

Continue reading “The Risks of Inaccurate HCC Coding: Why it Matters for Your Practice”

Here is the cheat sheet you’re looking for: DOWNLOAD    ICD-10 codes are hard. Knowing which codes to use for Risk Adjustment in your Value-Based Care is even harder. And even the best available clinician training rarely yields lasting behavior change. Your team needs a resource in your pocket, but a cheat sheet isn’t the …

Continue reading “New HCC Coding Cheat Sheet for 2022”

As a healthcare provider, you know the importance of accurately and consistently documenting diagnoses, but not just to align revenue – there is a far greater reason for specific, accurate HCC coding: patient care. One thing that is often overlooked when calculating RAF scores is the simple fact that Risk Adjustment Factor is the simplest …

Continue reading “How to wean your clinicians off HCC coding cheat sheets”

We get it, HCC coding is hard: choosing the right HCC is nuanced, and can seem subjective. But when you see a patient, you are probably not reaching for a cheat sheet on how to diagnose this patient, right? How is it that HCC coding sent you searching for a cheat sheet?   And learning …

Continue reading “So Your Team Downloaded Our Cheat Sheet…”

Fred Schulte, Kaiser Health News and Holly Hacker Republished with permission November 21, 2022 Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some plans overbilling the government more than $1,000 per patient a year on average.   Audits — Hidden Until Now — …

Continue reading “Bolus of Vintage CMS Audits Reveal Millions in MA Overcharges – KHN”

HCC Coding And RAF are vital to modern healthcare, and we’ve recently received some incredible client data we’d very much like to share. And we all know the perils of sharing a win that deals with customer data, which is in turn patient data. And by “perils,” what we really mean is impossibility. Sometimes, the …

Continue reading “There’s Something We’re Not Telling You About HCC Coding And RAF”

Revenue cycle management (RCM) is a hot topic this year. Monitoring, analyzing and improving the efficiency of your organization’s revenue processes is top of mind for leaders across many healthcare organizations. And you’ are probably still reading because you know that improving your organization’s revenue processes is essential to its success. But are you doing …

Continue reading “5 Ways to Improve Your Revenue Cycle Management Strategy”

In a move that surprised very few in healthcare—and fewer on Capitol Hill—SCOTUS refused to hear UnitedHealth’s case against the 2014 Medicare Advantage Overpayment Rule. In the case of UNITEDHEALTHCARE CO., ET AL. V. BECERRA, SEC. OF H&HS, ET AL. the lower court’s ruling stands.     Back in 2018, a Fierce Healthcare headline announced, …

Continue reading “SCOTUS Secures Medicare Advantage Overpayment Rule”

Notes and insights from a study published by AJMC on how to change physician behavior. “The authors evaluated methods for implementing clinical research and guidelines, in order to change physician practice patterns, in surgical and general practice. They evaluated the effectiveness of different implementation methods.”   And as we have demonstrated through successful behavior change …

Continue reading “How To Change Physician Behavior – from AJMC”

Medicare Advantage Compliance Audits: The Department of Health and Human Services Office of Inspector General regularly audits Medicare Advantage contracts and reports out specific diagnosis codes deemed improper. They also report the estimated overpayments associated with the specific diagnosis codes, and recommend repayments.  Below, you’ll find all of the specific “High Risk HCC codes” targeted …

Continue reading “6 Recent HHS OIG Medicare Advantage Compliance Audits”

Excerpts, notes and quotes from the DOJ 2021 Fiscal Year Report   The DOJ DOJ Healthcare Audits Charged $5 Billion In 2021, according to a recent report. The Department of Justice released an analysis of all False Claims Act settlements and judgments in fiscal year 2021, revealing $5 Billion against healthcare, out of a $5.6B …

Continue reading “DOJ Healthcare Audits Charged $5 Billion In 2021”

Excerpts from a study.   Humana’s Chief Medical Officer, William Shrank, MD, MSHS, co-wrote a study in March (published by JAMA)  titled “Analysis of Value-Based Payment and Acute Care Use Among Medicare Advantage Beneficiaries.” (Gondi S, Li Y, Drzayich Antol D, Boudreau E, Shrank WH, Powers BW. Analysis of Value-Based Payment and Acute Care Use …

Continue reading “Medicare Advantage: Value-Based Care Reduces Hospitalizations, Study”

A guest walks into an upscale hotel and unburdens himself of several suitcases into the waiting hands of an eager bellhop. When both arrive at the room, rather than giving a tip, the guest offers a hearty thanks! With a dry smile, the bellhop frankly states, “‘Thank you’ don’t feed the bulldog.”   And he’s …

Continue reading “Value-Based Care: It’s All About The Money”

We recently ran a poll asking how doctors preferred to learn about HCC documentation training tools and resources, and 50% selected “Peer Recommendations.” Fortunately, doctors just like you are using and loving our platform, and eager to share their experiences. We’ve broken their testimonials into three categories:  Ease of use, Depth of learning, Accuracy, and …

Continue reading “Four Reasons Health Professionals Love Our HCC Coding Education App”

DOJ vs Sutter Health – any time you see DOJ vs. Anybody, there is trouble brewing. But when it is a provider group, that looks like a sea-change. Live with Dr. Kazi is a new video series from Value-Based Care expert, Farshid Kazi, MD – Co-founder of DoctusTech, and passionate advocate for HCC coding and …

Continue reading “DOJ vs Sutter Health – Live with Dr. Kazi”

Sutter Health Settles with the DOJ is not a phrase we thought we’d ever see on our blog. We recently published a white paper on RADV audits and the importance of strict HCC compliance. A few weeks later, the Department of Justice announced a groundbreaking $90 million settlement with provider group Sutter Health.    In …

Continue reading “Sutter Health Settles with DOJ for $90 Million”

HCC Coding is Good For the Country – in the next installment of Live with Dr. Kazi, the new video series from Value-Based Care expert, Farshid Kazi, MD – Co-founder of DoctusTech, and passionate advocate for HCC coding and the Quadruple Aim.  In our third episode, Dr. Kazi shares ways in which HCC coding is …

Continue reading “HCC Coding is Good For the Country – Live with Dr. Kazi”

HCC Coding is Good For Providers – up next on Live with Dr. Kazi, a new video series from Value-Based Care expert, Farshid Kazi, MD – Co-founder of DoctusTech, and passionate advocate for HCC coding and the Quadruple Aim.  In our second episode, Dr. Kazi shares ways in which HCC coding is uniquely good for …

Continue reading “HCC Coding is Good For Providers – Live with Dr. Kazi”

Battling Physician Burnout is a top priority. One pillar of The Quadruple Aim is to Improve the clinician experience.    Even before the COVID crisis, Physician Burnout has been a growing concern. And after 18 months of increased workload and stress, the problem is getting worse, not better.   The Joint Commission Journal on Quality and …

Continue reading “Physician Burnout – Study Finds Work-Load Root Cause”

Live with Dr. Kazi – HCC Coding is Good For Patients Live with Dr. Kazi is a new video series from Value-Based Care expert, Farshid Kazi, MD – Co-founder of DoctusTech, and passionate advocate for HCC coding and the Quadruple Aim.  In our first episode, Dr. Kazi shares ways in which HCC coding is uniquely …

Continue reading “HCC Coding is Good For Patients – Live with Dr. Kazi”

RADV Audit White Paper – Planning Ahead For Strict HCC Compliance Protocols Key Findings on  From 400 RADV Audits, 2011-2021    What is a RADV Audit? The Medicare Risk Adjustment Validation Program (RADV Audit) was created to identify and correct past improper payments to Medicare providers and implement procedures to help the Centers for Medicare …

Continue reading “RADV Audit White Paper – Top 5 Takeaways”