Revisiting Payer Contract Review for Success in 2024
Healthcare providers should constantly be reviewing and assessing the performance of their payer contracts. But as the payer contract management environment continues to shift.
Why Medicare Advantage Plans And ACOs Need Experienced Vendors To Prepare For CMS-HCC Version 28
Medicare Advantage (MA) plans and Accountable Care Organizations (ACOs) should be reevaluating their vendor strategy in light of coming changes. This is largely because of a new version of the Hierarchical Condition Category (CMS-HCC) risk adjustment model that CMS released in 2023.
Details8 Signs You Should Invest In A Medical Coding Audit Before 2024
All the change in healthcare over the recent years has unfortunately meant new opportunities for abuses of medical billing. This kind of fraud and misuse puts providers at risk financially and ultimately jeopardizes the quality of care you can provide in the long term. Many providers who have realized this understand that now is a good…
DetailsWhy Self Audits Are One of the Most Valuable Medical Coding Audits
Medical coding audits are critical to a healthy revenue cycle, but with all the options, it is difficult to know where to position the different types of medical coding audit services in your revenue cycle management optimization strategy.
Risk Adjustment Reviews Are Your Key To Success In Value Based Contracts
Retrospective reviews of risk adjustment coding are foundational to the financial health and stability of Accountable Care Organizations (ACOs) and Medicare Advantage plans (MAPs). This is increasingly true as value-based contracts.
Value-Based Care and Analytics: R=1
R=1. An almost unattainable feat in the world of statistical analysis. R, the correlation coefficient, is the measurement of how closely two variables are related. The closer the value of R is to one, the stronger the correlation. A value of one signals absolute correlation, which is why in a real world application, this value […]
DetailsUpdates on MDPCP
The wait is over! The Maryland Primary Care Program (MDPCP) has been launched, 360 practices and their associated clinical transformation organizations (CTOs) are in performance year 1. The buzz is one of excitement mixed with some uncertainty. Maryland has been ready for a program that provides some financial capital to support care transformation and management […]
DetailsThe World of EMRs & Coding
EMRs have wreaked havoc with clinical documentation. When educating providers, one of the most challenging things to explain is why it is important to write out their clinical impression instead of depending on the diagnosis drop down menu. When they see the results of their audit, they are often confused as to why I have […]
DetailsThe Three T’s of an Office Move
Recently, we moved our office 1.3 miles down the road. This move, though not sizable in distance, forced us to change zip codes and phone numbers. But that was only the beginning. I was put in charge of the office move, and, going into the experience, I had no idea how many pieces there would […]
DetailsThe Importance of Specificity in Coding
Hierarchical condition categories (HCCs) utilize ICD-10 codes to determine risk scores for patients. Each applicable HCC is added up to determine the patient’s total risk adjustment factor (RAF). It is imperative to code with as much specificity as possible, in order to fully encapsulate the amount of resources expected to be needed for the patient. […]
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