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Exceptional Coders | Innovative Technology

DOJ Takes Action on Medicare Advantage Overpayments

Posted by David Fong on Sep 28, 2017 6:00:00 AM

As you are well aware, Congress created Medicare Advantage (MA) as a risk adjustment payment program that pays insurers more for sicker beneficiaries. Payers in MA receive a yearly fee for each enrolled member and monthly risk adjustment payments for each enrolled beneficiary, based partly on the person’s health status. This program can be open to fraud. Medicare Advantage payers received about $160 billion in 2015 for approximately 16 million beneficiaries. HHS estimates that the FY 2015 Medicare Part C gross improper payment estimate is 9.50 percent or $14.12 billion, along with the FY 2015 net improper payment estimate of 4.32 percent or $6.41 billion.


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Topics: Medical Coding, HCC Coding, Coding Compliance, Medical Coding Audits

Better Coding and Record Keeping Can Improve Care and Reimbursements for High-Risk Patients

Posted by David Fong on Aug 29, 2017 7:00:00 AM

An article in Modern Healthcare magazine reported that physicians who serve low-income patients with complex conditions are more vulnerable to financial losses in value-based payment models. The study that found these providers, many of them safety-net providers, didn't have the technological infrastructure to report the necessary data.


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Topics: Medical Coding, HCC Coding, Coding Compliance, Medical Coding Audits

HCC Coding Needs Rise as Medicare Advantage Gains Increased Popularity

Posted by David Fong on Jul 21, 2017 7:00:00 AM

Medicare Advantage (MA) is a complex program that continues to gain popularity, with about one-third of Medicare beneficiaries currently enrolled in a variety of MA programs. MA plans are issued by MAOs, or Medicare Advantage Organizations, that are typically insurance companies.

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Topics: Revenue Cycle Management, Medical Coding, HCC Coding