As OPPS packaging has increased, providers may be less likely to appeal claims for certain denied charges based on medically unlikely edits, since it would not increase payments. However, providers should consider appeals when services are medically necessary and appropriate, as CMS bases future payment rates on accepted claims.
HCCs are the basis for risk adjustments for reimbursement models like Medicare Advantage, accountable care organizations (ACO), and other value-based purchasing measures such as Medicare Spending Per Beneficiary. Poor understanding and application of HCCs mean that a hospital’s patients may be much sicker in reality than they appear to be on paper. And that will hit reimbursement hard.
Ever since Pat became a nurse case manager three years ago, both family and friends have reached out to her for healthcare advice. She really doesn’t mind and almost expects it, especially since healthcare can be complex and challenging. By sharing her knowledge as a case manager, Pat can often help people navigate healthcare complexities.
Ever since Pat became a nurse case manager three years ago, both family and friends have reached out to her for healthcare advice. She really doesn’t mind and almost expects it, especially since healthcare can be complex and challenging. By sharing her knowledge as a case manager, Pat can often help people navigate healthcare complexities.
