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Author : InnoviHealth Systems Inc
Publisher :
ISBN 13 : 9781640721210
Total Pages : pages
Book Rating : 4.7/5 (212 download)
Download or read book 2021 Risk Adjustment written by InnoviHealth Systems Inc and published by . This book was released on 2020-09-16 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Sheri Poe Bernard
Publisher : American Medical Association Press
ISBN 13 : 9781640160392
Total Pages : 500 pages
Book Rating : 4.1/5 (63 download)
Download or read book Risk Adjustment Documentation and Coding written by Sheri Poe Bernard and published by American Medical Association Press. This book was released on 2020-03-02 with total page 500 pages. Available in PDF, EPUB and Kindle. Book excerpt: Risk-adjustment practices consider chronic diseases as predictors of future health care needs and expenses. Correct and detailed documentation and compliant diagnosis coding are critical for proper risk adjustment. Risk Adjustment Documentation & Coding, 2nd Edition provides: Risk-adjustment parameters to improve documentation related to severity of illness and chronic diseases. Code abstraction guidelines and recommendations to improve diagnostic coding accuracy without causing financial harm to the practice or health facility. Chronic disease ICD-10-CM coding summaries for quick reference and study. The impact of risk-adjustment coding (hierarchical condition category (HCC) coding) on a practice should not be underestimated: More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States. Insurance risk pools under the Affordable Care Act include risk adjustment. CMS has proposed expanding audits on risk-adjustment coding. FEATURES AND BENEFITS Five chapters delivering an overview of risk adjustment, common administrative errors, best practices, and guidance for development of internal risk-adjustment coding policies. Ten chronic disease ICD-10-CM coding summaries for quick reference and study. Two appendices offering mappings and tabular information of ICD-10-CM codes that risk-adjust to HCCs and RxHCCs. Learning and design features: Vocabulary terms highlighted within the text and defined at the bottom of the page. "Advice/Alert Notes" that highlight important coding and documentation advice from federal regulatory sources. "Sidebars" that provide derivative story and additional information, such as "Coding Tips" that guide coders with practical advice from sources like AHA's Coding Clinic and cautionary notes about conflicts and exceptions "Clinical Examples" that underscore key documentation issues for risk adjustment "Clinical Coding Examples" that provide snippets or full encounter notes and codes to illustrate risk-adjustment coding and documentation concepts "Documentation tips" that highlight recommendations to physicians regarding what should be included in the medical record or how ICD-10-CM may classify specific terms "Examples" that explain difficult concepts and promote understanding of those concepts as they relate to a section "FYI" call outs that provide quick facts "Abstract & Code It!" exercises that test diagnosis abstraction and coding skills (exclusive to Chapter 4) Extensive end-of-chapter "Evaluate Your Understanding" sections that include multiple-choice questions, true-or false questions, audit and Internet-based exercises. Two downloadable course tests and slide presentations for each chapter. Exclusive content for academic educators: A test bank containing 100 questions and a mock risk-adjustment certification exam with 150 questions.
Author :
Publisher : Optum 360
ISBN 13 : 9781622544554
Total Pages : pages
Book Rating : 4.5/5 (445 download)
Download or read book Risk Adjustment Coding and Hcc Guide 2019 written by and published by Optum 360. This book was released on 2018-08-22 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The Risk Adjustment Coding and HCC Guide brings together hard-to-find information about risk adjustment (RA) coding and hierarchical condition categories (HCCs) in a new comprehensive resource that explains this complex reimbursement methodology. Now your organization will have a guide that provides both the big picture and the fine detail needed to document, code, and report essential information so that accurate risk levels are assigned and appropriate reimbursement received.
Author : Great Britain
Publisher :
ISBN 13 : 9780348222487
Total Pages : pages
Book Rating : 4.2/5 (224 download)
Download or read book The Solvency 2 (Credit Risk Adjustment) Regulations 2021 written by Great Britain and published by . This book was released on 2021-04-14 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Enabling power: S.I. 2019/407, reg. 2, sch. 1, para. 9 (b). Issued: 14.04.2021. Sifted: -. Made: 13.04.2021. Laid: 14.04.2021. Coming into force: 28.05.2021. Effect: None. Territorial extent & classification: E/W/S/NI. General. EC note: Commission Delegated Regulation (EU) No. 2015/35 amended
Author : OECD
Publisher : OECD Publishing
ISBN 13 : 9264480919
Total Pages : 275 pages
Book Rating : 4.2/5 (644 download)
Download or read book Health at a Glance 2021 OECD Indicators written by OECD and published by OECD Publishing. This book was released on 2021-11-09 with total page 275 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health at a Glance provides a comprehensive set of indicators on population health and health system performance across OECD members and key emerging economies. This edition has a special focus on the health impact of COVID-19 in OECD countries, including deaths and illness caused by the virus, adverse effects on access and quality of care, and the growing burden of mental ill-health.
Author : Department Of Health And Human Services
Publisher : Lulu.com
ISBN 13 : 9781716599989
Total Pages : 128 pages
Book Rating : 4.5/5 (999 download)
Download or read book ICD-10-CM Official Guidelines for Coding and Reporting - FY 2021 (October 1, 2020 - September 30, 2021) written by Department Of Health And Human Services and published by Lulu.com. This book was released on 2020-09-06 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt: These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. The instructions and conventions of the classification take precedence over guidelines. These guidelines are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.
Author : American Dental Association
Publisher : American Dental Association
ISBN 13 : 1941807712
Total Pages : 60 pages
Book Rating : 4.9/5 (418 download)
Download or read book Section 1557 of the Affordable Care Act written by American Dental Association and published by American Dental Association. This book was released on 2017-05-24 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.
Author : American Medical Association
Publisher :
ISBN 13 : 9781640160811
Total Pages : 1250 pages
Book Rating : 4.1/5 (68 download)
Download or read book ICD-10-CM 2021: The Complete Official Codebook with Guidelines written by American Medical Association and published by . This book was released on 2020-09-20 with total page 1250 pages. Available in PDF, EPUB and Kindle. Book excerpt: ICD-10-CM 2021: The Complete Official Codebook provides the entire updated code set for diagnostic coding, organized to make the challenge of accurate coding easier. This codebook is the cornerstone for establishing medical necessity, determining coverage and ensuring appropriate reimbursement. Each of the 21 chapters in the Tabular List of Diseases and Injuries is organized to provide quick and simple navigation to facilitate accurate coding. The book also contains supplementary appendixes including a coding tutorial, pharmacology listings, a list of valid three-character codes and additional information on Z-codes for long-term drug use and Z-codes that can only be used as a principal diagnosis. Official coding guidelines for 2021 are bound into this codebook. FEATURES AND BENEFITS Full list of code changes. Quickly see the complete list of new, revised, and deleted codes affecting the FY 2021 codes, including a conversion table and code changes by specialty. QPP symbol in the tabular section. The symbol identifies diagnosis codes associated with Quality Payment Program (QPP) measures under MACRA. New and updated coding tips. Obtain insight into coding for physician and outpatient settings. New and updated definitions in the tabular listing. Assign codes with confidence based on illustrations and definitions designed to highlight key components of the disease process or injury and provide better understanding of complex diagnostic terms. Intuitive features and format. This edition includes full-color illustrations and visual alerts, including color-coding and symbols that identify coding notes and instructions, additional character requirements, codes associated with CMS hierarchical condition categories (HCC), Medicare Code Edits (MCEs), manifestation codes, other specified codes, and unspecified codes. Placeholder X. This icon alerts the coder to an important ICD-10-CM convention--the use of a "placeholder X" for three-, four- and five-character codes requiring a seventh character extension. Coding guideline explanations and examples. Detailed explanations and examples related to application of the ICD-10-CM chapter guidelines are provided at the beginning of each chapter in the tabular section. Muscle/tendon translation table. This table is used to determine muscle/tendon action (flexor, extensor, other), which is a component of codes for acquired conditions and injuries affecting the muscles and tendons Index to Diseases and Injuries. Shaded guides to show indent levels for subentries. Appendices. Supplement your coding knowledge with information on proper coding practices, risk adjustment coding, pharmacology, and Z codes.
Author : United States Sentencing Commission
Publisher :
ISBN 13 :
Total Pages : 556 pages
Book Rating : 4.3/5 (91 download)
Download or read book Guidelines Manual written by United States Sentencing Commission and published by . This book was released on 1988 with total page 556 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : National Academies of Sciences Engineering and Medicine
Publisher :
ISBN 13 : 9780309685061
Total Pages : pages
Book Rating : 4.6/5 (85 download)
Download or read book The Future of Nursing 2020-2030 written by National Academies of Sciences Engineering and Medicine and published by . This book was released on 2021-09-30 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.
Author : Medical Coding Pro
Publisher :
ISBN 13 :
Total Pages : 156 pages
Book Rating : 4.5/5 (974 download)
Download or read book CRC Exam Study Guide - 2021 Edition written by Medical Coding Pro and published by . This book was released on 2021-01-19 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: The CRC Exam Study Guide 2021 Edition has been updated for 2021. It includes a 150 question practice exam, answers with full rationale, Medical Terminology, Common Anatomy, Tips to Passing the Exam, Secrets To Reducing Exam Stress, and Scoring Sheets. It is designed for students preparing for the Certified Risk Adjustment Coder certification exam after January 1, 2021. ***** Look at what some students had to say after using our practice exams ***** "I just wanted to let you know that I was preparing for the exam and took a practice exam and only made a 70%. I was somewhat skeptical of purchasing your strategies and practice in fear it would not help. Reluctantly, I purchased your product (a practice exam and the strategies to pass) before sitting for the exam. I received my results yesterday. I PASSED! I used all of the strategies you recommended (time management, highlighting, etc), which made all the difference in the world. Thank you so much!!!" - Heather T. "Great practice test... I passed the AAPC test the first try!" - Natalia "Great guide. It helped me pass the Certification Exam the first time!" - Dianne L. Bartos "This book was well worth my money. The exam tips were absolutely golden. No video on youtube can compare to the tips this book contains. When taking the actual exam, I applied all of the tips that I had learned from this study guide. It helped me to manage my time well. Thanks to this study guide and a lot of studying, and a lot of prayer, I was able to pass the real exam with an 81 on my first try. I highly recommend this if you are looking to take the test soon." - Gia Q "This is very good... I used your practice exam bundle and passed the first time. I also recommended this to others preparing for the test in our organization. They ordered and felt it was of great value. I especially appreciated the explanation for the answers which helped me learn while I corrected the test. When I took the practice test, I set a timer for 5 hr 40 min. and was able to complete in 3 hours with a score of 89%." - Linda B, CPC. "I purchased your practice exam package and think it's great. Using your tips, I completed all 150 questions in 297 minutes and scored an 84%." - Elizabeth H. "I am thrilled to report Greg that I passed my CPC Exam on December 12th!" - Kathleen C."Your test was amazing, it help me out a lot." - Vickey L."Well the practice test helped me pass my CPC exam. I got he good news last week!" - Erica J. "I wanted to thank you for the CPC practice exam. Thanks to the practice I was able to pass the CPC and CCA exams on the first take. Your exam really helped me work on timing and the lab questions were especially helpful." - Mark T. "Woooohooooo, I passed! I also went for the Medical Administration certificate and passed that as well. Thanks for all your hints and practice exams to help me pass. Wow I am glad that's over. Thanks again!" - Deanna A. "I did purchase the practice exam from you before the new year and I passed my CPC. I found out literally new years eve! Thanks for the great exam!" - Sabrina. "I took the CPC exam Dec. 7. As a matter of fact, I did pass the CPC exam and your practice exam helped. Thanks! Go ahead and list my name in your Certified Coders section." - Lester B. "I have passed the exam and thank you for all of your help with the preparation materials." - Victoria S.
Author : Thomas G. McGuire
Publisher : Academic Press
ISBN 13 : 012811326X
Total Pages : 659 pages
Book Rating : 4.1/5 (281 download)
Download or read book Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets written by Thomas G. McGuire and published by Academic Press. This book was released on 2018-08-06 with total page 659 pages. Available in PDF, EPUB and Kindle. Book excerpt: Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment. Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection Brings together international experience from many different countries that apply regulated competition in different ways Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness
Author : United States. Health Care Financing Administration
Publisher :
ISBN 13 :
Total Pages : 260 pages
Book Rating : 4.:/5 (3 download)
Download or read book Annual Report on Medicare written by United States. Health Care Financing Administration and published by . This book was released on 1980 with total page 260 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : American Medical Association
Publisher :
ISBN 13 : 9781640161559
Total Pages : 1250 pages
Book Rating : 4.1/5 (615 download)
Download or read book ICD-10-CM 2022 the Complete Official Codebook with Guidelines written by American Medical Association and published by . This book was released on 2021-09-20 with total page 1250 pages. Available in PDF, EPUB and Kindle. Book excerpt: ICD-10-CM 2022: The Complete Official Codebook provides the entire updated code set for diagnostic coding, organized to make the challenge of accurate coding easier. This codebook is the cornerstone for establishing medical necessity, correct documentation, determining coverage and ensuring appropriate reimbursement. Each of the 22 chapters in the Tabular List of Diseases and Injuries is organized to provide quick and simple navigation to facilitate accurate coding. The book also contains supplementary appendixes including a coding tutorial, pharmacology listings, a list of valid three-character codes and additional information on Z-codes for long-term drug use and Z-codes that can only be used as a principal diagnosis. Official 2022 coding guidelines are included in this codebook. FEATURES AND BENEFITS Full list of code changes. Quickly see the complete list of new, revised, and deleted codes affecting the CY2022 codes, including a conversion table and code changes by specialty. QPP symbol in the tabular section. The symbol identifies diagnosis codes associated with Quality Payment Program (QPP) measures under MACRA. New and updated coding tips. Obtain insight into coding for physician and outpatient settings. Chapter 22 features U-codes and coronavirus disease 2019 (COVID-19) codes Improved icon placement for ease of use New and updated definitions in the tabular listing. Assign codes with confidence based on illustrations and definitions designed to highlight key components of the disease process or injury and provide better understanding of complex diagnostic terms. Intuitive features and format. This edition includes color illustrations and visual alerts, including color-coding and symbols that identify coding notes and instructions, additional character requirements, codes associated with CMS hierarchical condition categories (HCC), Medicare Code Edits (MCEs), manifestation codes, other specified codes, and unspecified codes. Placeholder X. This icon alerts the coder to an important ICD-10-CM convention--the use of a "placeholder X" for three-, four- and five-character codes requiring a seventh character extension. Coding guideline explanations and examples. Detailed explanations and examples related to application of the ICD-10-CM chapter guidelines are provided at the beginning of each chapter in the tabular section. Muscle/tendon translation table. This table is used to determine muscle/tendon action (flexor, extensor, other), which is a component of codes for acquired conditions and injuries affecting the muscles and tendons Index to Diseases and Injuries. Shaded guides to show indent levels for subentries. Appendices. Supplement your coding knowledge with information on proper coding practices, risk-adjustment coding, pharmacology, and Z-codes.
Author : Lisa M. Lines
Publisher : RTI Press
ISBN 13 :
Total Pages : 24 pages
Book Rating : 4./5 ( download)
Download or read book Artificially Intelligent Social Risk Adjustment written by Lisa M. Lines and published by RTI Press. This book was released on 2022-09-13 with total page 24 pages. Available in PDF, EPUB and Kindle. Book excerpt: Prominent voices have called for a better way to measure, predict, and adjust for social factors in healthcare and population health. Local area characteristics are sometimes framed as a proxy for patient characteristics, but they are often independently associated with health outcomes. We have developed an “artificially intelligent” approach to risk adjustment for local social determinants of health (SDoH) using random forest models to understand life expectancy at the Census tract level. Our Local Social Inequity score draws on more than 150 neighborhood-level variables across 10 SDoH domains. As piloted in Ohio, the score explains 73 percent of the variation in life expectancy by Census tract, with a mean squared error of 4.47 years. Accurate multidimensional, cross-sector, small-area social risk scores could be useful in understanding the impact of healthcare innovations, payment models, and SDoH interventions in communities at higher risk for serious illnesses and diseases; identifying neighborhoods and areas at highest risk of poor outcomes for better targeting of interventions and resources; and accounting for factors outside of providers’ control for more fair and equitable performance/quality measurement and reimbursement.
Author : Lawton Robert Burns
Publisher : McGraw Hill Professional
ISBN 13 : 1264264488
Total Pages : 640 pages
Book Rating : 4.2/5 (642 download)
Download or read book The U.S. Healthcare Ecosystem: Payers, Providers, Producers written by Lawton Robert Burns and published by McGraw Hill Professional. This book was released on 2021-03-16 with total page 640 pages. Available in PDF, EPUB and Kindle. Book excerpt: An Essential Guide to the Processes and Operational Complexities of the U.S. Healthcare System The U.S. Healthcare Ecosystem serves as an expert navigator through the complicated and often confusing environment where healthcare payers, healthcare providers, and producers of healthcare technologies all interact. This thorough resource provides expert insight and analysis of employer-based health insurance, pharmacy benefits, the major professions, healthcare consolidation, drug discovery and development, biotechnology, and much more. Packed with timely examples and filled with illustrations, The U.S. Healthcare Ecosystem will inspire you to think more critically about the business of healthcare and make informed assessments. Features: Includes often neglected topics impacting healthcare delivery such as employer-based health insurance, pharmacy benefits, healthcare consolidation, and biotechnology Highly readable and single-authored by a Wharton Professor who has taught health care delivery and management for over 20 years Filled to the brim with helpful diagrams, charts and tables - nearly 350 figures complement the text Every chapter ends with a helpful Summary and Questions to Ponder
Author : The Coders Choice LLC
Publisher :
ISBN 13 : 9781698476964
Total Pages : 97 pages
Book Rating : 4.4/5 (769 download)
Download or read book MRA/HCC CHART REVIEW and DOCUMENTATION GUIDE written by The Coders Choice LLC and published by . This book was released on 2019-10-08 with total page 97 pages. Available in PDF, EPUB and Kindle. Book excerpt: A Hierarchical Condition Category (HCC) is defined as a risk adjustment model that is used to calculate risk scores to predict future healthcare costs. The Centers for Medicare and Medicaid Services' (CMS) CMS-HCC model is used to predict healthcare spending for Medicare Advantage Plan enrollees. The purpose of the scoring model is to adjust capitated payments made to beneficiaries in these plans based on the member's health. HCCs were initially implemented by CMS in 2000 and have been phased in over time. This article will focus on the CMS-HCC model.The model is based on diagnosis codes and includes 79 HCCs. Age, sex, disability, and living circumstances--such as whether the individual is living at home, in a nursing home, or in a long-term care facility--also play a part in the calculations of an HCC.
