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Third Pass: Risk Adjustment QA and Compliance
Compliance is an integral part of any risk adjustment strategy. The goal of capturing HCC codes is to accurately capture the full health status and disease burden of both individuals (and therefore populations) under value-based care. In this sense, the financial incentive is ultimately another tool CMS uses to motivate participants in risk-sharing arrangements towards […]
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Concurrent EDPS and RAPS support from Lumanent
Health Fidelity is pleased to share that the Lumanent platform is fully prepared to offer concurrent EDPS and RAPS support, congruent with the CMS-HCC risk adjustment model transition.
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The Opportunity and Benefits of the Clinical Review Specialist
A hallmark (and problem) of technology in healthcare has been the drive to automate processes and eliminate staff headcount to boost ROI. For risk adjustment operations in particular, this often results in an increased burden on physicians, asking them to learn and apply CPT, ICD-10, HCC, and any number of other codes alongside their primary […]
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Pre-Encounter Risk Adjustment: If You Try Sometimes, You Get What You Need
As the significance of provider risk adjustment grows, especially within the clinical workflow, finding the right solutions and adopting them in the right order is a critical part of success. Today, I want to discuss that, as well as exploring an unorthodox approach: using pre-encounter risk adjustment strategies that also supports care without burdening physicians […]
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Coders Code: The Imperative Reduction of Non-Clinical Work for Physicians
Healthcare is a technological paradox. On the clinical side, the bleeding edge of science and engineering present physicians with increasingly greater imaging tools, robotic surgical devices, gene-targeted therapy: the limits of what is technologically possible in healthcare are in lockstep with the limits of human understanding. At the same time, despite two decades of explosive […]
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Concurrent Coding Increases Claims Accuracy While Reflecting True Patient Disease Burden
Concurrent coding is an alternative audit process to correct documentation and coding errors that immediately follows the physician visit, before a claim is submitted for payment. Physicians are not coders, so concurrent coding finds billing oversights that physicians might overlook in the rush to complete electronic paperwork. Automating concurrent coding is available with the Lumanent Post-Encounter Review module from Health Fidelity.
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Big data. Artificial intelligence. Cognitive computing. Natural language processing. Machine learning. These terms have become the latest buzzwords in healthcare. But what do they mean?
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How Technology Can Help Ensure the Utmost Compliance in Your Risk Adjustment
Teresa Ross discusses the buzz around compliance in risk adjustment. Find out how technology-enabled solutions can help achieve the utmost compliance in an efficient and effective manner.
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Natural Language Processing Demystified
Christina Sung sits down with Dr. Rob Kalfus, Health Fidelity’s Clinical Informaticist, to address some commonly asked questions about Natural Language Processing. Rob delves into the application of NLP technology in risk adjustment and explains how Health Fidelity's technology is uniquely suited to healthcare.
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Are You Overestimating Risk Scores? Understanding Compliance and Penalties
Overlooking missed diagnoses is just half of the challenge of attaining accurate risk scores. Learn how solve the other half by applying technology to help with compliance in this post from Health Fidelity Director of Coding & Quality, Kathy Ormsby.
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Decreasing Inherent Waste in Coding Operations
With risk adjustment becoming increasingly important to the bottom line of health plans and the wellness of patients, Christina Sung offers strategies for organizations to adopt new coder technology with low time-to-value barriers.
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4 Steps to Turn Risk Adjustment into a Strategic Advantage
Most organizations view risk adjustment as a necessity, but not a strategic asset. With the right measures, risk adjustment can be leveraged as a competitive advantage.
