Three major types of payer record reviews are conducted every year: The Healthcare Effectiveness Data and Information Set (HEDIS), Medicare Risk Adjustment, and Commercial Risk Adjustment. As the volume of payer and health plan reviews continues to climb, millions of patient records are requested.
This week’s Medicare updates include a fact sheet on the 2018 EHR Incentive Program payment adjustment; transmittals regarding the January 2018 updates to the OPPS, ambulatory surgery center payment system, and physician fee schedule; a memo detailing three categories of sanctions for proficiency testing referrals; and more!
This month's security Q&A answers readers' questions on incidental disclosures, sending protected health information in the mail, and addressing vulnerabilities identified in a risk analysis.
It is widely accepted that multidisciplinary rounds are essential for the success of a case management department, especially in ensuring achievement of their metrics. Case management metrics have a broader scope, more so than ever before; the number of metrics, ranging from financial to quality, is growing all the time.
This week's note provides an overview of the eligibility, scope of coverage, effective dates, premiums, and cost-sharing amount policies under the four parts of Medicare. .
