I am hearing from several of my readers that the 2011 HCC model codes will implemented starting payment year 2011.  This means that the new code crosswalk (to be finalized April 5th by CMS) will be implemented during the following dates of service windows.  The January 2011 preliminary payment rates will be set by the July, 2009 to June, 2010 12 month dates of service window using the new codes.  The July 2011 payment rates will be set by dates of service in CY2010 using the new codes.

3 Comments

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  By ragnut, March 31, 2010 @ 9:49 AM

  Matt, to help me better understand how the scheduling of revenue payments works, please tell me which of these 2 statements best describes the situation where a new diagnosis of morbid obesity is made in August 2010:

  1) you won’t see additional reimbursement for this until July 2011. If you would have seen and coded this diagnosis before 7/1/10, you would have been reimbursed starting 1/1/11, and thus you have lost out on money

  2) Although you won’t see additional reimbursement until July 2011, you won’t lose money in the long run because the money “lost” from January 2011 thru June 2011 will be made up / reconciled because you still diagnosed the patient in calendar year 2010.
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  By J. Matt Yuill, M.D., CPC, March 31, 2010 @ 9:57 AM

  This statement is more applicable: 2) Although you won’t see additional reimbursement until July 2011, you won’t lose money in the long run because the money “lost” from January 2011 thru June 2011 will be made up / reconciled because you still diagnosed the patient in calendar year 2010.

  Thanks,
  Matt
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  By jmarino, March 31, 2010 @ 2:56 PM

  Hi Matt,
  per ragnut above…. 3/31/10 comment
  How can morbid obesity be paid for (risk adjust) in 2010 when it doesn’t go into effect until 2011?
  Thank you,

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