Modern Health Care is reporting today that the “Payment Rates for Insurers who sell Medicare Advantage Plans will rise by 0.85% instead of 1.35% in the Proposed Increase.

The most interesting fact about the size of the increase (very small) is that CMS took into account the way health plans code their members DIAGNOSES. THUS THE OVERALL PAYMENT AVERAGE WILL INCREASE BY only 3.05% instead the original February estimate of 3.55%. The estimate for the basis of all payments in this program are based on a variety of data which is derived from both the CLINICAL DOCUMENTATION AND THE CODING DATA.

Health Systems Management’s clients are faced with two major challenges both based on clinical data and both resulting in loss of revenue and fines. We have written in an earlier article that Physician Practices must have a solid plan which finds overpayments and returns them to CMS going back 6 years. And now because of the Coding issues there is a longer term effect that will reduce margins which are very small to begin with.

We have advised our clients throughout the country to begin a review process both for Hospital based care and Physician office encounters. Our firm has worked with our Hospital Clients and Large physician practices for 30 years on the basics of Clinical Documentation and Coding.

We have very successful hands on activities that involve both the Medical Staff and every process of the Revenue Cycle so that knowledge is transferred to internal staff so that there is a minimal of outside help. Please contact us if you have any questions or needs.

By: Cathy Idema, BSN, MPH, FAAHC