For Leprechaun Clients Only!

You are cordially invited to participate in Leprechaun’s HCC Physician Online courses. We have designed eleven (11) unique courses for:

1. Cardiology
2. Critical Care Medicine
3. Endocrinology
4. Gastroenterology
5. General Surgery
6. Geriatrics
7. Hematology-Oncology
8. Infectious Disease
9. Nephrology
10. Primary Care
11. Pulmonary Medicine

The Leprechaun Risk Adjustment Course for Physicians is a web based tool that:

1. Teaches physicians the basics of HCC Risk Adjustment
2. Introduces physicians to coding challenges specific to their specialties
3. Shows physicians their own historical coding patterns and compares them to those of their regional peers
4. Tests physicians’ understanding of the material and allows them to obtain continuing education credit after passing an examination

Each course provides a test to ensure a physician's undertanding of CMS risk adjustment and the importance of complete and correct coding in that system. The course is certified for one hour of continuing medical education (CEU). We suggest all primary care providers and high volume specialists take this course.

Remember, if it helps to change only one coding habit, it will pay for the program many times over.

For more information please contact your Leprechaun account manager.

Not Your Father's Medicare Advantage Plan

This article describes how one Medicare Advantage plan (HealthSpring) is using more pleasant office settings to differentiate themselves from other plans in the market.

Interestingly, the plan uses both high-tech electronic medical records (EMR) for providers and low-tech 3-ring binders for patients as part of its approach to "to track prescriptions and stay on top of chronic health problems".

The article closes with some specifics about the financial difference of properly coding for risk adjustment. Worth a read.

Busy Busy Busy

Open enrollment for Medicare plans kicked off on the 15th of this month, and most plans are preoccupied with marketing their product offerings.

Unfortunately, it's a bad time to take your eye off of your risk management program:

• Starting January 1st 2007, your revenues will be based 100 percent on the risk adjusted status of your members. Sadly, the time has long passed to impact your initial 2007 payments.
• January 31st is the deadline to submit RAPS data relevant to 2005 dates of service.
• In February you should begin your review of 2006 data for retrospective adjustment.
• March 2nd is the deadline for updating your members risk adjustment score for payments beginning July 1st 2007.

Medicare Advantage (MA) programs face a nearly continuous stream of important deadlines. Missing deadlines can mean the permanent loss of revenue (in the case of missing the deadline for 2005 dates of service) or a delay in receiving proper compensation based on the risk represented in your membership (in the case of missing a payment-adjustment deadline).

So, even though new members are important, if you don't have a good handle on risk adjustment, those new members could be digging you a deeper hole than the one you may be standing in. Good prospective and retrospective risk management techniques are the only answer to a financially healthy MA plan.

RAPS Submission Timetable

I'm always looking for one of these:




You can always find the current one here: http://www.csscoperations.com/new/rapformat/newraps.html

(along with other useful information about CMS's Risk Adjustment Payment System (RAPS), like record layouts, error codes, and the various files).

Check out Everything RAPS! in the Links section of the right sidebar!

Whither Managed Medicare?

This article, Managed Healthcare Revitalized, from Managed Care magazine had this excellent graphic (click the image for a larger version):



Of course, not everyone is convinced about the long-term prospects for managed Medicare:

The question is what happens when real risk adjustment cuts in. Then we’ll see if Medicare Advantage can sustain itself and innovate in terms of improving care delivery at a lower cost.

We agree that many plans will get a surprise in January when they see just what 100% risk adjusted payment means to their revenues.