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From Voluntary to Mandatory: CMS Is Rewiring eCQMs and dQMs – ICD10monitor
16+ hour, 27+ min ago (1471+ words) At the time of this writing, these provisions remain proposals, and may change when CMS publishes the final rule. Even so, the direction is becoming increasingly clear. CMS is building an environment in which quality results will be calculated from…...
Ethics, Risk Adjustment, and a Turning Point for Medicare Advantage – MedLearn Publishing
5+ mon, 2+ week ago (434+ words) The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) has repeatedly warned that such conduct undermines public trust. In announcing the settlement, HHS-OIG leadership emphasized that intentional inflation of diagnosis codes compromises the integrity of Medicare Advantage…...
Accepting Downcoded MA Payments: A Growing False Claims Risk for Hospitals – MedLearn Publishing
5+ mon, 3+ week ago (643+ words) Hospitals across the country are facing mounting financial pressure from Medicare Advantage (MA) plans. One increasingly common tactic used by MA payers is systematic downcoding: paying hospitals at a lower level of care or service than was billed. While many…...