What is HCC Coding in Risk Adjustment?
Despite the pivotal role value-based care has in healthcare in the United States, it’s often not well understood. In the same spirit in which we covered the basics of risk adjustment and two-sided risk, today we want to tackle HCC coding in risk adjustment. With any luck, you’ll come away with a better understanding of […]
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 […]
Machine Learning in Healthcare and the Value of Human Expertise
When discussing artificial intelligence like NLP, the use of machine learning in healthcare inevitably comes up, so today we’re going to clearly articulate what machine learning is, and how it can be best used. First, when people say machine learning (ML), they usually think of “unsupervised,” that is to say, build a machine learning algorithm, […]
HCC Recapture Rate for Disease Burden, Provider Performance, and COVID-19 Risk: How Prioritization Helps
An effective and essential risk adjustment strategy includes the prioritization of chronic condition recapture each year. The benefit of prioritizing your HCC recapture rate comes directly from the requirement of re-confirming a diagnosis and treating it. First, it ensures regular contact with clinicians to monitor and manage chronic conditions, overall improving the quality of care. […]
The Overlooked ROI: Redaction, Chart-Linking, and CMS Penalty Avoidance
Using a workflow enabled by technology that enables, and actively supports, both additions and redaction (deletion), isn’t just easy and cost effective, it has value beyond its intrinsic ROI. Chris Gluhak explains the importance of eliminating inaccurate codes while looking for potential additions to avoid CMS penalties in audits.
Six Emergent Best Practices in Telehealth Risk Adjustment Coding
Telemedicine is accelerating, in both adoption and refinement; review the emerging best practices for actionable insights to ensure effective submission and mitigate audit risk.
Accelerating Recovery in Reimbursement for Value-based Care Post COVID-19
Implementing a post-encounter coding review is an effective way to ensure complete and accurate capture of all 2020 risk adjustable conditions - without burdening clinical teams - while informing care and stabilizing revenue. Finding and closing these gaps today, with fee-for-service revenues having bottomed out and many provider organizations in a precarious financial position, is especially critical.
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 […]
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.
Hierarchical Condition Categories (HCC) Coding | Risk Adjustment
Coding, more specifically Hierarchical Condition Categories (HCC), is an important part of the ACA (Affordable Care Act aka Obamacare), Medicare Advantage, and Medicaid risk adjustment model for RAF (risk adjustment factor) score reimbursement. Find out more about coding in our blog.