Providers Leaving Money on the Table – Proper HCC Coding Eliminates It

by Phil C. Solomon May 26, 2017

The Centers for Medicare and Medicaid Service’s (CMS) Hierarchical Condition Category (HCC) risk adjustment model calculates risk scores, which will adjust capitated payments made for aged and disabled beneficiaries enrolled in Medicare Advantage (MA) and other plans. The CMS-HCC model design uses two risk segments with separate coefficients to reflect the cost patterns of beneficiaries.  The […]

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Administrative Burden of EHRs Opens Doors to Medical Scribes

by Phil C. Solomon May 17, 2017

A physician’s responsibility is to provide the best possible care for sick patients.  A key for delivering quality healthcare is open communication between the physician and patient to discuss issues and develop a care plan.  Today, providing quality care is becoming more difficult due to increasing patient loads and administrative challenges.  This dilemma has become […]

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The Business of Healthcare Overview That You Don’t Want to Miss

by Phil C. Solomon April 27, 2017

Interesting Facts About The Business of Healthcare If you have a question about the hospitals and the healthcare industry, you will probably find the answer here.  This article will give you some interesting facts about the industry in 2017. Healthcare makes up a large part of the Gross Domestic Product (GDP) in the US.  It […]

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American Health Care Act Update Review

by Phil C. Solomon March 21, 2017

The House proposal to “repeal and replace” the Affordable Care Act (ACA), the landmark and controversial legislation that is a signature of President Barack Obama’s administration, indicates that the nation’s healthcare system could be heading for yet another upheaval.  March 21, 2017 marked the seventh anniversary of the ACA.  Although there is still a high […]

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Consumers, Employers and Providers Take the Hit from Rising Healthcare Spending

by Phil C. Solomon March 17, 2017

Since the adoption of the Affordable Care Act (ACA) and the subsequent rules changes that have taken effect, comprehending the changes to the healthcare industry has become a difficult task for anyone, let alone consumers.  Keeping up with the transformation is difficult, even for industry insiders.  Recent news reports demonstrate this: ·       Aetna is pulling […]

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OIG Compliance – The Line In The Sand You Don’t Want to Cross

by Phil C. Solomon March 8, 2017

Understanding OIG Compliance Background On October 15, 1976, President Gerald Ford signed into law legislation creating an Office of Inspector General (OIG) at the Department of Health, Education and Welfare (HEW).  HEW OIG would become HHS-OIG in 1980 when the Department was redesignated as the Department of Health and Human Services (HHS). The OIG and […]

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Healthcare’s Newest Security Threat: IoT

by Phil C. Solomon February 1, 2017

One of the greatest technological achievements in the 21st Century was is the creation of the Internet.  Its formation has effectively changed almost every aspect of business and personal communication. The newest threat to cybersecurity is the proliferation of Internet of Things (IoT)—connected physical and smart devices that have embedded technologies including electronics, software or sensors that allow for network […]

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Enforcement Procedures Adjusted for Two-Midnight Rule

by Phil C. Solomon January 25, 2017

OIG Report Reveals Two-Midnight Rule Vulnerabilities A study by the Office of Inspector General (OIG) has revealed “vulnerabilities” under the Two-Midnight hospital policy that initially went into effect on October 1, 2013.  In response to the findings, OIG has recommended that the Centers for Medicare and Medicaid Services (CMS) improve oversight of hospital billing under […]

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ACA – First Steps Towards Repeal

by Phil C. Solomon January 23, 2017

Trump’s executive order on the ACA: 5 things to know This is an excellent summary written by Emily Rappleye of Beckers Hospital Review about President Trump’s position on the ACA and how he and his Cabinet are going to pursue repealing the ACA. President Donald Trump signed an executive order Friday evening aimed at immediately […]

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MACRA and the Medicare Payment Reform Juggernaut

by Phil C. Solomon January 18, 2017

The passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA)1  has contributed to changes in healthcare delivery by redesigning Medicare’s payment and delivery methods for physicians and other clinicians. MACRA repealed the highly debated sustainable growth rate (SGR) formula which eliminates the 21 percent across-the-board cut in Medicare’s […]

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Healthcare Consumerism Has “Won the Day”

by Phil C. Solomon January 10, 2017

Consumerism and Personal Debt Accumulation Merriam-Webster defines consumerism as the promotion of the consumer’s interests and the theory that an increasing consumption of goods is economically desirable.  The United States (U.S.) has become a society of increasing consumerism, where individuals are making increasing levels of purchases for a variety of consumer goods. Retailers and service […]

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Providers Are Leaving Money on the Table – Proper HCC Coding Fixes It

by Phil C. Solomon December 1, 2016

The Centers for Medicare and Medicaid Service’s (CMS) Hierarchical Condition Category (HCC) risk adjustment model calculates risk scores, which will adjust capitated payments made for aged and disabled beneficiaries enrolled in Medicare Advantage (MA) and other plans. The CMS-HCC model design uses two risk segments with separate coefficients to reflect the cost patterns of beneficiaries.  The […]

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