HCC scores have been used since 2004 by Medicare to adjust payments based on the risk level of the enrollee. This has resulted in Medicare paying a higher monthly capitation fee for patients with higher HCC scores as these patients require more resources and disease intervention. The HCC payment system uses ICD-10 codes and demographics to generate a risk adjustment factor (RAF) score which identifies patients that require higher cost to care for and is based on the diagnosis codes billed in the previous review period.
Understanding net collection rates will help you to gain a better understanding of how much money that is owed to your practice is collected. Calculating your collection rate is quite simple, but it offers an excellent understanding of where your business stands and how you can improve it through medical billing operations.
Calculating your Net Collection Rate
The net collection rate holds a barometer to the health of your medical practice.
One of the most complicated administrative practices in the medical profession is medical billing. Medical billing is an integral administrative aspect of the medical profession, and it is such a comprehensive task that it requires a whole new department of professionals who are proficient in billing practices in order to deliver results in a swift and efficient manner.
Medical billing is a tedious and challenging job that needs special attention in order to ensure optimal competence. Although most doctors and hospital have an in house billing staff or get it done themselves, they are hardly qualified or trained to oversee the intricacies of billing efficiently. This is why it is important to invest in the services of a quality healthcare billing company.
Have you ever experienced a situation when you have been made to pay a bill twice for the same product? This is exactly what is happening in the healthcare industry. According to a recent study published in the New England Journal of Medicine, surprise medical bills have been presented to 22% of ER visits or Emergency Room visits.
The latest in a series of steps taken by the Centers for Medicare and Medicaid Services (CMS) to incentivize care quality over volume; MACRA was signed into law in 2015 and replaces the previous Medicare reimbursement schedule to a new pay-for-performance program that’s focused on quality and accountability. Starting January 1, 2017, all Medicare Part B providers will enter a new payment framework called the Quality Payment Program,
In response to the demand for improving the capture of chronic illness diagnoses for reimbursements, the Center for Medicare and Medicaid Services (CMS) mandated the development of the Hierarchical Categorical Condition (HCC) code system and implemented it in the year 2004. The incorporation of the HCC codes has helped drive CMS payments to Medicare Advantage (MA) members.
With healthcare reform and system changes underway, accurate medical documentation and coding is critical to the financial health of your practice and to the health of your patients. In 2004 Medicare implemented an HCC (Hierarchical Condition Categories) model to adjust capitation payments to private health care plans for the health expenditure risk of their enrollees.
Representing a departure from the volume based, fee-for-service model, MACRA replaces the SGR (sustainable growth rate) formula to control Medicare costs. Linking Medicare reimbursements to quality metrics with providers being rewarded for quality and value based care; MACRA repeals the set payment rates based on economic growth, which was the hallmark of SGR.
Healthcare practices typically outsource their billing for two reasons – lack of resources and/or lack of time. While outsourcing your billing has many advantages, there are certain factors that need to be checked before hiring a billing company. Remember that most outsourcing contracts generally last for two to three years and it would be detrimental to your practice if you choose a billing company that exhibits most of the following:
- The billing company has no existing clients with the same specialty as yours.