Maximum Diagnosis Codes Submission on Claim Forms

January 23, 2018

We are frequently asked by clients and others in the industry about the number of diagnosis codes allowed on the electronic format as well as the paper forms when billing for services. This is especially true in risk adjustment where all current diagnoses are collected for financial forecasting purposes. Some try to use claim editing to capture these but ultimately a medical record review by an experience risk adjustment coding…


Understanding Important Facts Around the ACA and Potential Replacement or Revisions

February 28, 2017

The Patient Protection and Affordable Care Act (PPACA), commonly shortened to the Affordable Care Act (ACA) and nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Why Did We Need the ACA (Obamacare)? In 1980, 25 million Americans were uninsured, and by 2009, it increased to 51 million (Bodenheimer/Grumbach, 2012). While many…


FAQ’s on Risk Adjustment

September 28, 2016

FAQ’s on Risk Adjustment Brian Boyce, BSHS, CPC, CPC-I, CRC, CTPRP Risk adjustment is a new payment methodology that is prospective in nature; meaning that instead of paying for costs after services are rendered, we are estimating costs in future years based on what we know to be true of the patient in the recent and current years. This article will cover the basics of risk adjustment, where to find…