RN-Coder Network
Call 855-987-6268 Monday - Friday            8am - 4pm Pacific
 
RN-Coder Network provides HCC-ICD9 "live" seminar training for groups at your location.  Minimum is 10 registrants and the sponsoring organization provides the location.

Group discounts available for 10 - 15 registrants, 16 - 25 registrants, and         26 - 50 registrants.

The RN-Coder     HCC-ICD9 training is also available as an online program with group discounts available as well.

Please use the Contact Pageto send us your questions about hosting an     RN-Coder HCC-ICD9 program at your location.

Please contact RN-Coder Network to perform your PCP and other chart reviews.  We have very competitive per-chart rates!  All of our RN reviewers are Certified RN-Coders and/or Certified RN-Auditors.  Please CONTACT 

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HCC - Medicare Risk Adjustment


DID YOU KNOW: Certified RN-Coders are Among the Brightest and the Best at 

Performing ICD9/HCC Chart Reviews!


Whether your Medicare Advantage plan delivers the PCP or specialist charts by appropriate dates of service digitally, or you need the CRN-C reviewers to obtain relevant ICD9 for you at the medical offices or hospital, one thing is certain: Certified RN-Coders are your single best resource for  ICD9 code validation for Medicare compliance!


The RN-Coder Network is the only company in the United States exclusively providing specially-trained RN Coder-Auditors for Medicare Advantage plans.  And NO!  It doesn't cost more -- having mored productive Certified RN-Coders obtaining the ICD9 codes literally increases your Return on Investment.  The RNs know exactly what they are looking for, find it efficiently with our software -- and can audit more charts in less time than non-clinical personnel.


Currently we have over 1500 trained and Certified RN-Coders all over the US, ready and waiting to perform onsite chart reviews and digital reviews.  Pricing varies by type of chart, location, total number of charts to be reviewed and timeframe.


A Southern California-based company, the RN-CODER NETWORK was established to assist IPAs and Medicare Advantage Health Plans in obtaining full premium revenue for their Medicare Advantage members. The goal of the RN-CODER NETWORK is to help clients achieve accurate and complete documentation, diagnosis coding and reporting of their Medicare Advantage patients’ health status.


With costs rising and revenue sources diminishing, Medicare Advantage Plans and their risk partners can ill afford to fail to identify their members’ relative severity of illness - the key to Medicare’s premium calculation. Accuracy in medical chart documentation is essential to proper and complete reimbursement for Medicare Advantage members. The RN-CODER NETWORK’s analytic software, developed by clinicians such as Internal Medicine physicians and RNs with extensive chart review experience with HCCs, helps Health Plans and their risk partners receive the full measure of premium revenue for their members.


By eliminating up to 1/3 of the charts (infectious disease, for example), Clients can choose the optimal point of their investment and maximize return by greatly reducing the time and expense required to review charts. When THE RN-CODER NETWORK's AUDITR coding software is employed by Certified RN-Coders, the chart review becomes focused and efficient. 


Our results:


  • Findings increase 40% over standard reviews by non-clinical coders
  • Return on Client investment approaching 8 to 1 and higher


Organized by a team of HCC physicians, nurses, and managed care executives, the RN-CODER NETWORK has developed software and techniques to pinpoint diagnoses in the medical chart that have not been recorded or inaccurately recorded according to CMS guidelines.  


The RN-CODER NETWORK's software based systems have dramatically improved members' risk scores.


ARTICLE: “Lax Coding by Physicians Hurts Medicare Advantage Plans”  


By assisting doctors, insurers can get all the payment that they are due.


By Marcia Naveh, MD

Health insurers participating in managed Medicare have never experienced as wide a gap between actual and potential payment as currently exists. Simply stated, Medicare managed care payments from the Centers for Medicare & Medicaid Services depend on accurate and complete diagnostic physician coding.


However, the economics of running a physician practice penalize those who take the extra time to code completely. The physician coding that health plans rely on to set their premium payment levels is incomplete and inaccurate, and as a result, many health plans currently receive dramatically lower premiums than those to which they are entitled. That need not be the case, however.



RECENT HISTORY 


Ideally, plans that enroll more complex patients will receive higher premiums from Medicare to provide the necessary services. Proper HCC classification depends on both a plan’s ability to obtain accurate diagnostic information and a plan’s ability to report that information accurately to CMS. Although this sounds simple, it has proven to be quite challenging from both an operational and clinical perspective.

Obtaining the complete diagnosis data needed for accurate risk adjustment is fraught with challenges. CMS accepts information regarding a member’s health status from limited sources, one major one being medical charts from physician offices.


Unfortunately, physicians are not trained or motivated to document the complete spectrum of applicable diagnosis codes during an office visit, as only one valid diagnosis code is required for the physician to receive compensation. 


The health plan, however, must obtain every existing diagnosis coded in order to obtain an appropriate risk score and receive proper payment from CMS. Failure to do so can cost plans millions of dollars per year that could be used to provide needed medical services to members.


Consider this: A patient has a cold but has suffered a previous stroke, is diabetic and has Parkinson’s disease, congestive heart failure, and high blood pressure. The physician is paid based on whether the visit is short, medium, or long, and she codes one diagnosis: upper respiratory infection. While the physician is paid correctly for the visit, the plan may not get paid the proper premium if the physician fails to report a code or does not provide the necessary specificity in coding to document the complexity and anticipated cost of the disease.


In all likelihood, this patient will be hospitalized, perhaps incurring a catastrophic two- or three-week stay in the intensive care unit. Because this member’s risk score was never properly obtained, the MA plan did not accumulate the necessary reserves to provide for this event.


Now let’s suppose that the physician is trained to perform a comprehensive evaluation of all relevant diagnoses and properly documents each relevant diagnosis code. The next challenge is to get that information to CMS. Under the HCC system, patients with complex medical problems are at highest risk of being scored too low in the risk assessment.


Such patients can require 10 to 20 ICD-9 codes to accurately reflect their health status. Because most medical billing intermediaries (clearinghouses) truncate after four ICD-9 codes, these patients at highest risk will not have their risk adjusted properly, and, once again, the plan will not receive the appropriate payment.


FINANCIAL PENALTY

From a clinical perspective there are more serious challenges. Under Medicare+Choice, health plans were penalized financially for enrolling sicker members, because payment did not reflect complexity. Under HCC methodology, plans have an incentive to enroll sicker members. Assuming ideal circumstances, a Medicare Advantage plan has processes in place to ensure both comprehensive diagnosis coding and accurate submission to CMS.


But those are ideal circumstances.

Does your MA plan have access to the necessary robust resources (hospitals, nursing homes, home care, case management, disease management) to manage the complex medical needs of the population it now insures? More importantly, does the health plan have the technology to identify the patients who would benefit from additional resources and monitor their utilization and progress? Under the HCC risk system, it is essential that plans deploy all necessary resources to achieve better outcomes and avoid catastrophic events.


Although the challenges of the HCC system are daunting, the system offers significant rewards and opportunities for plans willing to embrace the change. CMS has stated that the Medicare Modernization Act is a budget-neutral program. Total premiums distributed to participating Medicare Advantage plans will not be allowed to increase under the HCC payment system. How the premium dollars are divided among the plans will, however, change dramatically.