Understanding the Impact of Accurate HCC Coding on Medicare Risk Adjustment

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In today’s complex healthcare system, the importance of accurate coding cannot be overstated, especially regarding Hierarchical Condition Categories (HCC) coding and Medicare risk adjustment. These components are vital in ensuring that healthcare providers are adequately reimbursed while complying with regulatory requirements. For organizations that handle Medicare Advantage patients, understanding and implementing accurate HCC coding practices…

RECORDED WEBINAR: Mitigating Medical Coding Compliance Risk in Value-Based Care

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 Download Slides Accurate coding is extremely important in the era of value-based care. If coding is inaccurate, it can result in significant financial penalties, damage to reputation, and missed opportunities to maximize reimbursements. Additionally, adherence to key compliance requirements and good clinical documentation practices are essential to avoid legal and financial repercussions. Key Takeaways:…

Up Your Coding Game to Better Leverage SDOH

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Applying data governance strategies can help healthcare facilities capture and use social determinants of health (SDOH) data, and a key part of that process is appropriate coding, according to an American Health Information Management Association (AHIMA) white paper. “When it comes to revenue cycle, I think what it comes down to is quality,” Julie A. Pursley, MSHI, RHIA,…

Why PCPs Should Focus on Coding and Documentation in Value-Based Care Programs

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Each year, a growing number of providers are entering value-based care arrangements, including primary care providers (PCPs). Given their holistic view of patients, PCPs are the best types of clinicians to drive value-based care. Medicare’s Primary Care Transformation programs and many payer-developed value-based care contracts are proof of the move for PCPs to be at…

Training clinicians and residents to succeed in value-based care

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As providers and payers invest in the move from volume to value, they are facing the reality that clinicians are lacking when it comes to training, education, and technology specific to enabling value-based care over fee-for-service. In order to succeed in this transition, practicing clinicians and emerging residents need hands-on support and investment to evolve,…

RECORDED WEBINAR: Risk Adjustment Coding & Its Impact on ACO Performance

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Download Slides  Each year, CMS sets cost benchmarks for every Medicare member based on the patients’ demographics and diagnoses during the assessment period. But what if the physician didn’t report their patients’ diagnoses accurately or specifically? The result is often benchmarks that are set appropriately low based on the information provided by the physician, and…