Medicare+Choice risk adjustment: don't leave money on the table.
The Principal In-Patient Diagnostic Cost Group (PIP-DCG) risk-adjustment methodology for Medicare+Choice organizations uses inpatient hospital encounter data to trigger payment for certain diagnoses. Improved financial performance under PIP-DCG risk adjustment for Medicare+Choice organizations and their hospital partners lies in more complete and accurate coding and better record-keeping at the hospital level. It is important to track members with chronic or terminal conditions that may qualify for higher payments and to appropriately code these conditions to optimize funds that may be owed to the organization.
Gorman
J K
JK
Managed Care Compliance Solutions, Inc., Washington, D.C., USA. gorman@capalliance.com
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D003953:Diagnosis-Related Groups / Q000145:classification / Q000191:economics*; D017598:Efficiency, Organizational; D017050:Episode of Care; D005377:Financial Management, Hospital / Q000379:methods*; D005568:Forms and Records Control; D006279:Health Maintenance Organizations / Q000191:economics*; D006801:Humans; D008329:Managed Care Programs; D020398:Medicare Part C / Q000458:organization & administration*; D020379:Risk Adjustment / Q000379:methods*; D014481:United States