HCCs: The Role of CDI and Risk Scores

Predicting coding patterns using the HCC risk scores can be a valuable endeavor. EDITOR’S NOTE: Longtime RACmonitor contributing correspondent Frank Cohen, a senior healthcare analyst,

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Warning: Medicare Rates Up in 2023

New deductibles and payment rates lead to new patient financial obligations for 2023. EDITOR’S NOTE: Listen to Dr. Ronald Hirsch’s live reporting Monday on Monitor

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Is Medicare Advantage Really a Disadvantage?

EDITOR’S NOTE: Terry Fletcher reported this story on Talk Ten Tuesdays earlier today. Her story is part of growing evidence of misdeeds by some Medicare

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OIG Faults MAOs for Inappropriate Denials

OIG report: widespread and persistent problems related to inappropriate denials of services and payment by Medicare Advantage Organizations. Organizations continue to find the management of

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The Problem with Problem Lists

Problem lists are a problem because often they are not updated. Over the last year, we have heard much about Medicare Advantage (MA) health plans

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What was Medicare Thinking?

Often, the rules do not make sense from a compliance or best-practices perspective. Medicare has a reputation of putting out policy that many feel is

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Doing the Right Thing

Doing what’s right is never wrong! Over the last six months we’ve all read the disappointing stories about some of the missteps (intentional or unintentional)

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