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HCC Recapture is Critical, HCC Recapture is Never Enough
Recently, we discussed the imperative of HCC recapture, especially in a year with encounter volumes heavily disrupted by COVID-19. However, HCC recapture is only a small part of the larger goal: discerning a complete and accurate risk profile of a covered population. With an accurate risk score, reimbursement can match the total cost of necessary […]
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CMS Policy Update on Encounter Data and Positive Risk Score Impact
On September 14th, CMS released part I of an advanced notice on risk adjustment for Medicare Advantage. The advanced notice itself has caused a stir despite being an update on the already in-progress transition toward the exclusive use of EDPS (encounter data processing system) for risk adjustment data submission, and the phasing out of RAPS […]
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Risk Adjustment and Telehealth Policy under COVID-19
Health Fidelity offers conclusions on the flurry of CDC and CMS telehealth policy updates around coding and risk adjustment practices under COVID-19
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Identifying Risk Adjustable Telehealth Patients in a Post COVID-19 World
Health Fidelity looked for a way to harness our expertise to assist our payer and provider partners provide continuity of care to their chronically ill patients. We decided to help providers identify and prioritize those patients who would be best served by telemedicine via a simple and quick suspecting report.
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The Opportunities of Technology-Enabled Risk-Sharing
Over 10% of the U.S. population is now covered by an accountable care organization (ACO), and the number of risk-adjusted lives is growing at roughly 15% to 20% each year. To date, risk adjustment has primarily consisted of payers retrospectively reconciling work done with payments owed. What impact will tech-enabled risk sharing have on these […]
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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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Value-Based Care is Here to Stay: Key Strategies for Developing a Risk Adjustment Program
Our comprehensive, encounter-centric framework helps providers develop an effective risk capture program to achieve success in value-based care.
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3 Takeaways to Look for at RISE West
If compliance is a key priority for your organization, we’ve put together a brief “playbook” of the areas we recommend you explore during your 2017 RISE West Summit trip.
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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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Clinical Data Acquisition with Technology
Vast amounts of clinical data are generated daily, but traditional methods of collecting and making use of it are inadequate. Adam Gronsky explores options for risk-bearing entities to invest in technology-enabled solutions that require minimal maintenance and decrease the need for manual retrieval in this month's post.
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360-Degree Risk Adjustment: A Strategic Lever for Risk-Bearing Entities
Steve Whitehurst presents three reasons why the 360-Degree Risk Adjustment strategic framework for optimizing coding performance needs to be part of any risk-bearing organization's 2017 plans.
