Hayes' Healthcare Blog

HCC model: Down to the Basics from Coding to Documentation

Posted by Johanna Legaspi on March 30, 2016 at 9:00 AM

The Basics

Hierarchical Condition Categories (HCC) were mandated in 1997 by the Centers for Medicare and Medicaid Services (CMS) and have been the basis for reimbursement for Medicare Advantage plans (MA) since 2004. HCCs use data to prospectively estimate predicted costs for enrolled members during the next year of coverage. These estimates are based on demographic information such as age and major medical conditions documented in the previous 12-month period. They are used to adjust Medicare capitation payments to Medicare Advantage health plans based on the anticipated risk of enrollees calculated from relevant ICD-10-CM codes.

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Topics: compliance, HCC, Coding and Documentation

3 Evolving Revenue Cycle Trends: Leveraging Them to Improve Financial Viability

Posted by Celeste Daye on March 23, 2016 at 9:00 AM

Celeste Daye, Senior Director Patient Financial Services, Dana Farber Cancer Institute

Healthcare finance executives from leading healthcare organizations like the Mayo Clinic, Kaiser Permanente, and the Cleveland Clinic have dubbed 2016 the “year of integration” for revenue cycle. They see consolidating complex revenue systems as the best way to reduce waste, increase efficiency, and improve the patient experience. One of the key aspects of such integration is involving the patient more in the financial aspects of their care.[1]

At Dana Farber Cancer Institute, the shift to value-based care, the evolving consumer mentality in healthcare, and a greater focus on clinical care plans are key changes impacting our revenue cycle. We not only recognize these fundamental changes, but are working to leverage them to benefit the organization.

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Topics: revenue cycle management, value-based care, Hayes Thought Leadership Blog Series, healthcare landscape evolution

Fee-For-Service to Value-Based Care: The Future is Now

Posted by Don Michaels, Ph.D. on March 9, 2016 at 9:00 AM

The U.S. Department of Health and Human Services (HHS) has a stated goal of shifting 85% of Medicare fee-for-service reimbursement into value-based models by 2016. Private payers will no doubt follow close behind. Meeting this aggressive goal is causing angst among healthcare providers with much conjecture about what it means for their organizations going forward.

The future, however, isn’t as bleak as it may seem. Several forward-looking organizations have leapt into the breach and embraced the change. Although there have been bumps along the way, a few have successfully made the transition and offer both a preview into life in the new reimbursement model world and examples of what you need to do as a provider organization to be successful.

Here are three examples.

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Topics: ACOs, Fee-for-service, value-based care

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