Empirical Risk Management
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:

MRA Alert

View Kameron Gifford, CPC's profile on LinkedIn

Subscribe to MRA Alert

Be the first to know with real time alerts and updates

24.02.2020
MRA Alerts and Updates
No comments
2020 HCC Coding Essentials - All NEW for the V24 Model Prepare your team for victory this risk adjustment season with the CMS-HCC Coding Essentials Pack. Includes all of the following: 2020 CMS-HCC Disease Factors – includes RAF for both Non-Dual and Dual members. 2020 CMS-HCC Trump Chart – Is your practice limited in the number of diagnoses you can submit per claim? This chart is a valuable resource to assist you in working smarter, not harder! 2020 CMS New and Continuing Enrollee Factors - for both Aged and Disabled members, plus Medicaid and Disabled Factors. 2020 Interaction Factors - CMS adds these factors to offset the additional resources needed to care for patients with certain co-existing conditions. 2020 Payment Count Factors - Additional factors will be added to the risk score when a patient has at least 4 payment HCCs. EHR Guide - Reduce keystrokes and choices when searching for diagnoses in your EHR. This double sided guide includes the most common ICD-10 codes. Post one by every workstation.  Top Missed HCCs - Great education piece. A provider favorite!  - All Printed on extra thick 14 pt. cardstock to last all year. Click here to learn more or place your order! 
15.02.2020
MRA Alerts and Updates
No comments
Is your organization participating? Primary Care First Model Options is a set of voluntary five-year payment options that reward value and quality by offering an innovative payment structure to support delivery of advanced primary care. Primary Care First is based on the underlying principles of the existing CPC+ model design: prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes.  Primary Care First Model Options will be offered in 26 regions for a 2021 start date: Alaska (statewide), Arkansas (statewide), California (statewide), Colorado (statewide), Delaware (statewide), Florida (statewide), Greater Buffalo region (New York), Greater Kansas City region (Kansas and Missouri), Greater Philadelphia region (Pennsylvania), Hawaii (statewide), Louisiana (statewide), Maine (statewide), Massachusetts (statewide), Michigan (statewide), Montana (statewide), Nebraska (statewide), New Hampshire (statewide), New Jersey (statewide), North Dakota (statewide), North Hudson-Capital region (New York), Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky), Oklahoma (statewide), Oregon (statewide), Rhode Island (statewide), Tennessee (statewide), and Virginia (statewide). The PCF model includes professional population-based payments and flat primary care visit fees to help practices improve access to care and transition from FFS to population-based payments.  If your practice is located in one of the 26 regions and has at least 800 FFS Medicare patients, you should strongly consider particpating in the PCF model.   Primary Care First practices may also participate in ACOs in the Medicare Shared Savings Program (Shared Savings Program). Primary Care First practices may not participate in the Next Generation ACO Model or the Comprehensive End Stage Renal Disease (ESRD) Care Model.  Learn more here: https://innovation.cms.gov/Files/slides/pcf-payment-slides.pdf If you have any questions or need additional guidance navigating the Primary Care First Model, ERM Consulting can help! ERM Consulting Inc. Todd Gifford, MBA, CRC  tgifford@ermconsultinginc.com 772-267-8156 Kameron Gifford, CPC kgifford@ermconsultinginc.com 772-267-9453
04.02.2020
MRA Alerts and Updates
1 Comments
2020 HCC Quick Coders are ready for shipping! CMS HCC Quick Coder Completely updated for 2020 - Version 24 This 40 page guide contains everything you need to calculate a risk score in one place! Includes 200+ of the most common HCC codes in the Medicare (CMS-HCC) model. This guide was designed for providers, with codes sorted alphabetically rather than by code. Order one for the entire team today! Includes: List of ICD-10 Guidelines 270 ICD-10 Codes (Rx and HCCs) Quality CPT II codes for MIPS / MACRA 2020 CMS-HCC Factors (includes demographic, disease and interaction) 2020 Trump Chart Orders of 100 or more can be white labeled with your logo at no charge. Please email logo to orders@ermconsultinginc.com after purchase. Visit https://erm.ecwid.com/ to see learn more and place your order.
03.02.2020
MRA Alerts and Updates
No comments
CMS published the Advance Notice on January 6th 2020 NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties SUBJECT: Advance Notice of Methodological Changes for Calendar Year (CY) 2021 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies – Part I, CMS-HCC Risk Adjustment Model Medicare Advantage has been successful in providing Medicare beneficiaries with options so that they can choose the healthcare that best fits their individual health needs. The Medicare Advantage program demonstrates bringing the value of private sector innovation and creativity to a government program, and CMS is committed to continuing to strengthen Medicare Advantage by promoting greater innovation, transparency, flexibility, and program simplification. A key element in the success of Medicare Advantage is ensuring that payments to plans reflect the relative risk of the people who enroll. A critical tool that CMS uses to accomplish that goal is the risk adjustment models that adjust payments based on the characteristics and health conditions of each plan’s enrollees. Summary of Proposal for CY 2021  For CY 2021 CMS is proposing to continue using the CMS-HCC model that was implemented in CY 2020 (i.e., 2020 CMS-HCC model). CMS is proposing to continue using the 2020 CMSHCC model to calculate encounter data-based scores and the 2017 CMS-HCC model to calculate RAPS-based scores. Under this proposal, 75% of the risk score would be calculated with the 2020 CMS-HCC model and 25% of the risk score would be calculated with the 2017 CMS-HCC model. Proposal for 2021 and Three-year Phase-in 2019 - 2022  The 21st Century Cures Act requires that any changes to risk adjusted payments under section 1853(a)(1)(C)(i) resulting from the implementation of section 1853(a)(1)(I) must be phased in over a three-year period, beginning with 2019, with such changes being fully implemented for 2022 and subsequent years. The statute thus requires a three-year phase-in over a four-year period. In the CY 2019 Advance Notice, we explained how we interpreted the statute’s direction to mean that the proposed changes to the risk adjustment model under section 1853(a)(1)(C)(i) could be implemented in 2019 without all the required provisions from section 1853(a)(1)(I), and could be further modified and implemented fully consistent with provisions from section 1853(a)(1)(I) for 2020. The model finalized for 2020 included modifications to meet all of the provisions from section 1853(a)(1)(I), and will be phased in over three years such that 100% of risk adjusted payments to MA organizations and certain demonstrations for 2022 are based on a risk adjustment model that complies with the statutory requirements in section 1853(a)(1)(I) of the Act. In order to phase in a model that meets the statutory requirements, risk score calculation for payment to MA organizations and certain demonstrations during the phase-in period reflects the transtion as follows: For Payment Year 2019, we are calculating risk scores using the sum of: 25% of the risk score calculated with the 2019 CMS-HCC model and  75% of the risk score calculated with the 2017 CMS-HCC model.  For Payment Year 2020, we are calculating risk scores using the sum of: 50% of the risk score calculated with the 2020 CMS-HCC model and  50% of the risk score calculated with the 2017 CMS-HCC model.  For Payment Year 2021, we propose to continue the phase in of the changes to the model by calculating risk scores using the sum of: 75% of the risk score calculated with the 2020 CMS-HCC model and  25% of the risk score calculated with the 2017 CMS-HCC model.  For PACE organizations, we propose to continue to use the 2017 CMS-HCC model to calculate risk scores in CY 2021, as described in the CY 2020 Advance Notice Part II and CY 2020 Rate Announcement. Encounter Data as a Diagnosis Source for 2021  For CY 2020, CMS is calculating risk scores for payment to MA organizations and certain demonstrations by adding 50% of the risk score calculated using risk adjustment eligible diagnoses identified from encounter data, FFS claims, and RAPS inpatient records with 50% of the risk score calculated using risk adjustment eligible diagnoses identified from RAPS data and FFS claims. For CY 2021, CMS proposes to calculate risk scores for payment to MA organizations and certain demonstrations by adding 75% of the risk score calculated using risk adjustment eligible diagnoses identified from encounter data, FFS claims, and RAPS inpatient records with 25% of the risk score calculated with risk adjustment eligible diagnoses identified from all RAPS data and FFS claims. Specifically, we propose to calculate the encounter data-based risk scores as follows: With the 2020 CMS-HCC model,  Using risk adjustment eligible diagnoses from encounter data, FFS claims, and RAPS inpatient records.  RAPS-based risk scores would be calculated as follows: With the 2017 CMS-HCC model,  Using risk adjustment eligible diagnoses from RAPS data and FFS claims Thus, as proposed, encounter data-based risk scores would only be calculated with the 2020 CMS-HCC model. For PACE organizations for CY 2021, we propose to continue the same method of calculating risk scores that we have been using since CY 2015, which is to pool risk adjustment-eligible diagnoses from the following sources to calculate a single risk score (with no weighting): (1) encounter data, (2) RAPS data, and (3) FFS claims Read the entire advance notice here The Final Rate Announcement For CY 2021, CMS will announce the Medicare Advantage capitation rates and final payment policies no later than Monday, April 6, 2020, in accordance with the timetable established in section 1853(b)(2), as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173) and the Securing Fairness in Regulatory Timing Act of 2015 (SFRTA) (Pub. L. 114-106). '
09.01.2020
MRA Alerts and Updates
No comments
  Have you registered for a workshop in 2020?     If not, here are the top 5 reasons to attend:       #5 - I am a coder who needs CEUs from the AAPC      #4 - I am a physician who needs CMEs from the AMA and/or AAFP             #3 - I want to learn how HCCs impact value-based contracts.             #2 - I want to learn more about HCC coding and clinical documentation.       #1 - I am looking for the best HCC tools available.      Download the agenda to learn more.          OR... register your team using the links below.  Advanced Risk Management - Improve the accuracy of your risk scores!  Are you looking for the best education available in risk adjustment, value-based payments and/or CDI? Good News - You have found it! Join us for a day of risk adjustment, catch up with colleagues over lunch, and get the best tools in the industry for FREE! Do you need CMEs or CEUs? We have that too! All Workshops are approved by the American Medical Association, American Academy of Family Practice and the American Academy of Professional Coders. Register your team ( 3 or more) today to save 10% on any 2020 Workshop! Take advantage of Early Bird pricing and Save $100! Overview: Vast changes are coming to risk adjustment in 2020. What should your team be doing now to prepare? What are the potential impacts to revenue? Discuss the importance of managing HCCs year over year. What resources are available from CMS to help?  Discuss the impact of shifting from RAPS to EDS. What does this mean for office based claims? Take a deep dive into HCC Coding and Documentation. Review NEW HCCs for 2020 and see what documentation is needed to validate payment. Learn how to leverage frontline staff to be successful in the world of risk adjustment and value-based payments. Download the Agenda Here Who Should Attend? -Providers - MDs, DOs, PAs, and NPs -Medical Directors - Medicare Advantage, ACOs, CPC+ and Medicaid -Hospitals and Academic Medical Centers -Medical Coders, Billers and CDI Specialists -Executive Leaders, Administrators, Directors and Managers -MSO and IPA Teams -Rural Health Centers, FQHCs and Community Health Centers -Health Alliance Members and Medical Society Members -Medicare, Medicare Advantage, Medicaid and Commercial Plans    REGISTER BELOW: Jacksonville on 2/13/2020 Tampa on 3/12/2020 Orlando on 5/9/2020 Each Attendee will Receive ($130):  - Color copy of the presentation  - 2020 CMS-HCC Quick Coder  - Laminated HCC and CDI Tools  - CME from AAFP and AMA  - CEU from AAPC To SPONSOR an EVENT Please email Kameron Gifford Early Bird Pricing and Group Discounts Register NOW to save $100 with Early Bird Pricing! Bring the WHOLE TEAM!  Register 3 and save 10% on your order!  Register 4 and use the code TEAM4 to save 20% on your order!
17.10.2019
MRA Alerts and Updates
No comments
Advanced Risk Management - Improve the accuracy of your risk scores!  Are you looking for the best education available in risk adjustment, value-based payments and/or CDI? Good News - You have found it! Join us for a day of risk adjustment, catch up with colleagues over lunch, and get the best tools in the industry for FREE! Do you need CMEs or CEUs? We have that too! All Workshops are approved by the American Medical Association, American Academy of Family Practice and the American Academy of Professional Coders. Register your team ( 3 or more) today to save 10% on any 2020 Workshop! Take advantage of Early Bird pricing and Save $100! Overview: Vast changes are coming to risk adjustment in 2020. What should your team be doing now to prepare? What are the potential impacts to revenue? Discuss the importance of managing HCCs year over year. What resources are available from CMS to help?  Discuss the impact of shifting from RAPS to EDS. What does this mean for office based claims? Take a deep dive into HCC Coding and Documentation. Review NEW HCCs for 2020 and see what documentation is needed to validate payment. Learn how to leverage frontline staff to be successful in the world of risk adjustment and value-based payments. Download the Agenda Here Who Should Attend? -Providers - MDs, DOs, PAs, and NPs -Medical Directors - Medicare Advantage, ACOs, CPC+ and Medicaid -Hospitals and Academic Medical Centers -Medical Coders, Billers and CDI Specialists -Executive Leaders, Administrators, Directors and Managers -MSO and IPA Teams -Rural Health Centers, FQHCs and Community Health Centers -Health Alliance Members and Medical Society Members -Medicare, Medicare Advantage, Medicaid and Commercial Plans    REGISTER BELOW: Jacksonville on 2/13/2020 Tampa on 3/12/2020 Orlando on 5/9/2020 Each Attendee will Receive ($130):  - Color copy of the presentation  - 2020 CMS-HCC Quick Coder  - Laminated HCC and CDI Tools  - CME from AAFP and AMA  - CEU from AAPC To SPONSOR an EVENT Please email Kameron Gifford Early Bird Pricing and Group Discounts Register NOW to save $100 with Early Bird Pricing! Bring the WHOLE TEAM!  Register 3 and save 10% on your order!  Register 4 and use the code TEAM4 to save 20% on your order!
13.09.2019
MRA Alerts and Updates
No comments
Opioids: What’s an “Outlier Prescriber”? Listening Session — September 17 Tuesday, September 17 from 4:30 to 6 pm ET Register for Medicare Learning Network events. Are you a physician, nurse practitioner, other advanced practice nurse, or physician assistant who prescribes opioids? CMS wants your input on how best to implement Section 6065 of the SUPPORT Act.  Signed into law in October 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) outlines national strategies to help address opioid misuse. As part of Section 6065 of the SUPPORT Act, CMS is required to notify opioid prescribers with prescription patterns identified as “outliers” compared to their peers and encourage them to reference established opioid prescribing guidelines.  The purpose of this listening session is to get feedback on the following topics: Methodology to establish outlier prescriber thresholds Tone and content of feedback reports to clinicians How to best identify a “medical specialty” from the National Provider Identifier framework How to define geographic areas for analysis Recommendations on opioid prescribing guidelines to include with the notification You are encouraged to review the following materials before the call: SUPPORT Act Centers for Disease Control and Prevention (CDC) Guideline 2016 CDC Advisory Food and Drug Administration Safety Alert Target Audience: All prescribing clinicians.
07.05.2019
MRA Alerts and Updates
1 Comments
JOIN US IN ORLANDO on MAY 15TH FOR THE LAST WORKSHOP OF THE YEAR.   Are you looking for the best education available in risk adjustment, value-based payments and/or CDI?   Good News - You have found it! Join us for a day of risk adjustment, catch up with colleagues over lunch, and get the best tools in the industry for FREE! Do you need CMEs or CEUs? We have that too! Workshops are approved by the American Medical Association, American Academy of Family Practice for 6 hours of CME and the American Academy of Professional Coders for 7 hours of CEUs. Overview: CMS confirms new HCCs for PY2020 – What should your team be doing now to prepare? ·       EDPS is here to stay – How can you ensure accurate risk scores with the transition away from RAPS? ·       Work Smarter not Harder – Take a deep dive into HCC coding… Who Should Attend? Medical Coders and Billers Providers, Managers and Frontline Staff CDI Specialists Executive Leaders ACO, MSO and IPA Teams Rural Health Centers Health Alliance Members Medicare, Medicaid and Commercial Plans REGISTER BELOW: For Orlando on 5/15/2019 To SPONSOR an EVENT Please email Kameron Gifford
03.05.2019
MRA Alerts and Updates
No comments
HCC CODERS / AUDITORS  ERM Consulting is looking for several HCC Coders and Auditors for remote and on-site positions.  HCC Coders / Auditors will be primarily responsible for conducting reviews of medical records and validating submitted diagnoses codes to ensure all diagnoses and services are accurately and completely coded.  HCC Coders / Auditors will also support a variety of other efforts including but not limited to: Identifying errors / opportunities in clinical documentation and coding.  Tracking and trending audit results and preparing reports. Identifying members with "dropped" and / or "suspect" HCC conditions.  Completing supplemental data reports for clients.  Onsite education and training for providers and coders. Facilitating efficient and effective interventions to ensure accurate and complete coding.  PLEASE NOTE- LOCATION is Fort Lauderdale, Florida for on-site positions.  What you'll do: Review submitted medical records and identify and code all ICD-10-CM diagnoses that map to a Risk Adjusted HCC and/ or RxHCC ensuring the documentation meets all CMS standard requirements for valid HCC submission. Oversee the outreach/intervention strategy and participates in ongoing development to determine best practices approach with members and providers to assist in improving risk adjustment factors. Work with clients to optimize risk adjustment efforts including communicate opportunities to collaborate and provide updates regarding risk adjustment efforts. To be considered for this position, you must have: High School Diploma or equivalent Current AAPC CPC (Certified Professional Coder) or AHIMA CCS (Certified Coding Specialist) credential is required. CRC (Certified Risk Coder) Certification within 6 months post hire. 5+ years recent experience in medical record review, diagnosis coding, and/or auditing is required. 8+ years general coding and / or billing experience. An equivalent combination of education and experience may be substituted for this requirement. The strongest candidates for this position will also possess: An Associate's degree from an accredited college or university. Experience with Medicare and/or Commercial risk adjustment Experience with Medicare and/or Commercial risk adjustment process is preferred. Experience/understanding of electronic medical & health records is preferred. Please email resumes to Kameron Gifford - kgifford@ermconsultinginc.com
30.01.2019
MRA Alerts and Updates
No comments
All NEW 2019 Advanced Risk Management Workshops Are you looking for the best education available in risk adjustment, value-based payments and/or CDI?   Good News - You have found it! Join us for a day of risk adjustment, catch up with colleagues over lunch, and get the best tools in the industry for FREE! Do you need CMEs or CEUs? We have that too! All Workshops are approved by the American Medical Association, American Academy of Family Practice and the American Academy of Professional Coders for CMEs and CEUs. Overview: What is changing for risk adjustment in the V23 model? New ICD-10 codes and HCC categories are here. What should your team be doing now to be successful? Review the different risk adjustment models and their impact on medical practice management for 2020 and beyond. CMS has proposed new HCCs for PY 2020. What should you be doing now to prepare? Discuss the impact of shifting from RAPS to EDS. What does this mean for office based claims? Take a deep dive into HCC Coding and Documentation. Review real documentation examples to see what validates, what doesn’t, and why.    Learn how to leverage frontline staff to be successful in the world of risk adjustment and value-based payments.  Download the Agenda Here Who Should Attend? Medical Coders and Billers Providers, Managers and Frontline Staff CDI Specialists Executive Leaders ACO, MSO and IPA Teams Rural Health Centers Health Alliance Members Medicare, Medicaid and Commercial Plans REGISTER BELOW: For Jacksonville on 2/21/2019 For  PBG - SOLD OUT  For Ft. Lauderdale on 4/25/2019 For Orlando on 5/15/2019 HOTELS near UNF in Jacksonville for 2/21/2019 Tru by Hilton Jacksonville St. Johns Town Center, 4640 Tropea Way, Jacksonville, FL 32246-8586 - 1.4 miles from University of North Florida Sheraton Jacksonville Hotel, 10605 Deerwood Park Blvd, Jacksonville, FL 32256-0509 - 2.3 miles from University of North Florida Hilton Garden Inn Jacksonville JTB / Deerwood Park, 9745 Gate Pkwy N, Jacksonville, FL 32246-8221 - 2.6 miles from University of North Florida 1 To SPONSOR an EVENT Please email Kameron Gifford Early Bird Pricing and Group Discounts Register NOW to save $100 with Early Bird Pricing! Bring the WHOLE TEAM to save 10% on your order!
Print Print | Sitemap Recommend this page Recommend this page
© ERM Consulting Inc