El ajuste de riesgos de Medicare alcanza un nuevo nivel
Ehe Medicare Risk Adjustment
(MRA) phase-in period has reached another level. All dates of service
on or between January 1, 2005, and December 31, 2005, will be subject
to reimbursement based 75 percent on risk adjustment; reimbursement
for those dates of service will be received in 2006. The next level
of reimbursement will be based on 100 percent risk adjustment; payment
for that level begins on January 1, 2007.
Here are some reminders about MRA as the next phase-in period approaches:
- New ICD-9-CM codes were announced on October 1, 2005. For more
information about these changes, visit the Centers for Medicare
& Medicaid Services (CMS) Web site at www.cms.hhs.gov/medlearn/icd9code.asp y www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3888.pdf.
- Humana is introducing Humana e-STAR, a Web-based tool that gives
physicians the ability to update the status of their members’
suspect conditions in Humana’s internal tracking mechanism,
the Humana STAR database. Using Humana e-STAR will replace the
former procedure of making notes on paper-based condition reports,
which will help ease the administrative burden in physicians’
offices and improve accuracy. Humana e-STAR users will be able
to print current member listings based on selection criteria,
view activity logs showing all updates to their Humana-insured
patients’ suspect conditions and view a condition-status
report, detailing average risk scores by provider within the group
and the market in total. Physicians interested in signing up at
no cost for Humana’s
e-STAR application should contact their local Medicare Risk Adjustment
representative. Once sign-up is complete, Humana e-STAR can be
accessed via the secure Provider Resource Center on www.humana.com.
Click on the “Humana e-STAR” link in the Resources
and Communications section.
- The next CMS data validation will take place at the end of first
quarter 2006. Once results of the last CMS data validation process
are received and analyzed, Humana will share them with the physicians
who participated and share lessons learned with all network physicians.
- Practices should continue to accurately report ICD-9-CM diagnosis
codes, including secondary diagnoses, to the highest level of
specificity. Also, practices should strive to maintain accurate
and complete medical record documentation to facilitate the data
validation process.
Physicians with additional questions about
Medicare risk adjustment can contact the Humana MRA department at
(866) 836-6658 or mra@humana.com.
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