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Coding - Practice Guidelines and Tips - 2024
Medical Record Requests for the HHS-operated Risk Adjustment Data Validation (HHS-RADV) Audit

The current HHS-RADV audit pertains to services provided during the 2023 calendar year. The requesting entity has determined that one or more of your patients are included in the HHS-RADV audit sample for services rendered during 2023. Because 2023 HHS-RADV medical record review is time sensitive, your immediate attention to this request is appreciated.

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Risk Adjustment Data Validation Audit
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Major Depressive Disorder, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for Major Depressive Disorder.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Seizure Disorders and Convulsions, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for common types of Seizure Disorders and Convulsions.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
HIV Clinical Practice Guidelines
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Documentation
  
Behavioral Health and Foster Care - Patient Resource - 2020
Frequently Asked Questions Clinical Document Submission Methods for Health and Recovery Plans (HARP) / Healthfirst Personal Wellness Plan (PWP)
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HARP Health And Recovery Plan
  
Behavioral Health and Foster Care - Patient Resource - 2020
Sample: Adult BH HCBS Plan of Care
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HARP Health And Recovery Plan
  
Behavioral Health and Foster Care - Patient Resource - 2020
Elements of a Complete Plan of Care (POC) Health and Recovery Plans (HARP) / Healthfirst Personal Wellness Plan (PWP)
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HARP Health And Recovery Plan
  
Behavioral Health and Foster Care - Patient Resource - 2020
Level of Service Request (LOSR) Minimum Requirements for BH HCBS Health and Recovery Plans (HARP) / Healthfirst Personal Wellness Plan (PWP)
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HARP Health And Recovery Plan
  
Provider Alerts - Policy, Billing, or Coverage Update - 2022
Coverage of Lung Cancer Screening with Low Dose Computed Tomography

Effective February 10, 2022, the Centers for Medicare & Medicaid Services (CMS) has expanded eligibility for people with Medicare to qualify for lung cancer screening with Low Dose Computed Tomography (LDCT) by lowering the starting age for screening from 55 to 50 years, and also by reducing the tobacco smoking history from at least 30 packs per year to at least 20 packs per year.

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Medicare
Medicaid
  
Claims & Billing - Practice Guidelines and Tips - 2023
eviCore Quick Reference Guide

View this eviCore QRG for resources and phone numbers.

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Documentation
  
Quality Program Resources - Education Events & Patient Care Resources - Provider Resources - 2023
Special Needs Plan Model of Care Annual Evaluation for 2023

Special Needs Plan Model of Care training module, updated for 2023. The Healthfirst Model of Care strives to meet the specialized needs of its members and to optimize their health outcomes by using evidence-based practices with an appropriate network of providers and specialists.

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Documentation
  
Claims & Billing - Policy, Billing, or Coverage Update - 2022
New CMS Modifiers for Distinct Procedural Services (59 Modifier)
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Reimbursement
  
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