In October 2024, the Task Force turned 10 years old. In recognition of this anniversary, the Task Force released a two-part paper reflecting on the past 10 years of health care transformation and envisioning a path forward for the coming decade. The Task Force’s original vision and guiding principles remain sound today, providing a strong…
Accountable Care Organizations (ACOs) are designed to streamline patient care while optimizing healthcare costs and improving outcomes. However, one key aspect that many ACOs grapple with is ensuring accurate and compliant coding and billing practices. Coding and billing compliance are essential in preventing costly errors, minimizing revenue leakage, and maintaining regulatory adherence, which is vital…
In today’s complex healthcare system, the importance of accurate coding cannot be overstated, especially regarding Hierarchical Condition Categories (HCC) coding and Medicare risk adjustment. These components are vital in ensuring that healthcare providers are adequately reimbursed while complying with regulatory requirements. For organizations that handle Medicare Advantage patients, understanding and implementing accurate HCC coding practices…
Download Slides Each year, CMS sets cost benchmarks for every Medicare member based on the patients’ demographics and diagnoses during the assessment period. But what if the physician didn’t report their patients’ diagnoses accurately or specifically? The result is often benchmarks that are set appropriately low based on the information provided by the physician, and…