Empirical Risk Management
Where to Find Us:
Empirical Risk Management
Phone: 772-210-2823
Fax: 772-210-2824
Kameron Gifford, CPC
772-267-9453
Todd Gifford, MBA
772-267-8156
What's New
ERM has a NEW Blog:
ShareKnowledge is Power...
ERM's Collection of the Most Valuable Resources on the Web
Graves vs Plaza Medical Centers
2.2017
Graves vs. PMC 5th Amended Complaint.pdf
Adobe Acrobat document [707.6 KB]
2.2017
Graves vs. PMC 5th Amended Complaint.pdf
Adobe Acrobat document [707.6 KB]
Report and Recommendation
Graves vs Plaza Medical Centers 2.17.2017
Report and Recommendation (Graves vs. PM[...]
Adobe Acrobat document [141.9 KB]
Graves vs Plaza Medical Centers 2.17.2017
Report and Recommendation (Graves vs. PM[...]
Adobe Acrobat document [141.9 KB]
2017 CMS-HCC and Rx-HCC Mappings
Final ICD-10 Mappings
2017 Midyear_Final ICD-10-CM Mappings.xl[...]
Microsoft Excel sheet [507.4 KB]
Final ICD-10 Mappings
2017 Midyear_Final ICD-10-CM Mappings.xl[...]
Microsoft Excel sheet [507.4 KB]
Commercial Risk Adjustment Mappings
Tables include Demographics, CPT and ICD-10
HHS HCC FY 2016 Tables.xlsx
Microsoft Excel sheet [293.8 KB]
Tables include Demographics, CPT and ICD-10
HHS HCC FY 2016 Tables.xlsx
Microsoft Excel sheet [293.8 KB]
2017 CMS Final Call Letter
Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter
Announcement2017.pdf
Adobe Acrobat document [2.3 MB]
Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter
Announcement2017.pdf
Adobe Acrobat document [2.3 MB]
2016 CMS Final Call Letter
Announcement of Calendar Year (CY) 2016 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter
Announcement2016.pdf
Adobe Acrobat document [1.8 MB]
Announcement of Calendar Year (CY) 2016 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter
Announcement2016.pdf
Adobe Acrobat document [1.8 MB]
CMS 2014 Final Call Letter
Announcement of Calendar Year (CY) 2014 Medicare Advantage Capitation
Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter
CMS 2014 Final Call Letter.pdf
Adobe Acrobat document [1.3 MB]
Announcement of Calendar Year (CY) 2014 Medicare Advantage Capitation
Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter
CMS 2014 Final Call Letter.pdf
Adobe Acrobat document [1.3 MB]
Medicare Managed Care Manual Chapters 21 and 9
Medicare Managed Care Manual
Chapter 21 – Compliance Program Guidelines and Prescription Drug Benefit Manual
Chapter 9 - Compliance Program Guidelines
(Chapter 21 - Rev. 110, 01-11-13)
(Chapter 9 -
Medicare Managed Care Manual Chapter 21.[...]
Adobe Acrobat document [289.6 KB]
Medicare Managed Care Manual
Chapter 21 – Compliance Program Guidelines and Prescription Drug Benefit Manual
Chapter 9 - Compliance Program Guidelines
(Chapter 21 - Rev. 110, 01-11-13)
(Chapter 9 -
Medicare Managed Care Manual Chapter 21.[...]
Adobe Acrobat document [289.6 KB]
Medicare Managed Care Manual Chapter 13
Medicare Managed Care Manual
Chapter 13 - Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals Applicable to Medicare Advantage Plans, Cost Plans, and Health Care Pre
Medicare Managed Care Manual Chapter 13.[...]
Adobe Acrobat document [427.0 KB]
Medicare Managed Care Manual
Chapter 13 - Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals Applicable to Medicare Advantage Plans, Cost Plans, and Health Care Pre
Medicare Managed Care Manual Chapter 13.[...]
Adobe Acrobat document [427.0 KB]
Managed Care Appeals Flow Chart
Medicare Managed Care (Part C - Medicare Advantage)
60 days to file
Automatic forwarding to IRE
if plan reconsideration upholds denial
60 days to file
60 days to file
60 days to file
AIC = Amount In C
Managed Care Appeals Flow.pdf
Adobe Acrobat document [83.2 KB]
Medicare Managed Care (Part C - Medicare Advantage)
60 days to file
Automatic forwarding to IRE
if plan reconsideration upholds denial
60 days to file
60 days to file
60 days to file
AIC = Amount In C
Managed Care Appeals Flow.pdf
Adobe Acrobat document [83.2 KB]
Federal Register Vol. 78 5/23/2013
Centers for Medicare & Medicaid Services
42 CFR Parts 422 and 423
Vol. 78 Thursday,
No. 100 May 23, 2013
Medicare Program; Medical Loss Ratio Requirements for the Medicare
Advantage and the Medicare P
Federal Register 5.23.2013 2013-12156.pd[...]
Adobe Acrobat document [463.0 KB]
Centers for Medicare & Medicaid Services
42 CFR Parts 422 and 423
Vol. 78 Thursday,
No. 100 May 23, 2013
Medicare Program; Medical Loss Ratio Requirements for the Medicare
Advantage and the Medicare P
Federal Register 5.23.2013 2013-12156.pd[...]
Adobe Acrobat document [463.0 KB]
Exploring the Digital Nation: America's Emerging Online Experience
Prepared by the NTIA and the Economics and Statistics Administration in the US. Dept. of Commerce. June 2013
exploring_the_digital_nation_-_americas_[...]
Adobe Acrobat document [2.4 MB]
Prepared by the NTIA and the Economics and Statistics Administration in the US. Dept. of Commerce. June 2013
exploring_the_digital_nation_-_americas_[...]
Adobe Acrobat document [2.4 MB]
New HIPPA requirements effective September 23, 2013
Atty.Hales.HIPAA.Provider.9.23.2013.Requ[...]
Adobe Acrobat document [187.6 KB]
Atty.Hales.HIPAA.Provider.9.23.2013.Requ[...]
Adobe Acrobat document [187.6 KB]
Print 