Accountable Care Organizations (ACOs) are designed to streamline patient care while optimizing healthcare costs and improving outcomes. However, one key aspect that many ACOs grapple with is ensuring accurate and compliant coding and billing practices. Coding and billing compliance are essential in preventing costly errors, minimizing revenue leakage, and maintaining regulatory adherence, which is vital…
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…
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:…
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,…
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…
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,…
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…