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.
After ICD-10 went live on October 1, 2015; CMS (Centers for Medicare and Medicaid Services) allowed a one year grace period for ICD-10 flexibility, to overcome the strong opposition from the AMA (American Medical Association) to ICD-10 implementation. For the one year period, even though a more specific code existed, CMS allowed healthcare providers to submit claims with a valid code from the ICD-10 three character category,
In order to keep your practice afloat, it is imperative that your services receive full and timely reimbursements. Getting your cash flow moving smoothly depends on accurate coding along with timely submission of your bills to the relevant insurance carriers. Incorrect coding can lead to your reimbursements being delayed, denied or rejected. If you have a small or specialty practice,