Inferscience

  Although revenue from risk-based contracts continues to increase for medical groups of all sizes, motivating providers to fully participate in their organization’s risk adjustment efforts remains a challenge for healthcare organization leaders. Because of this, many organization leaders have started looking for different ways to motivate their teams of providers to drive better engagement in HCC Coding & risk adjustment documentation. In our first blog post of this series, we discussed the importance of HCC coding and optimal documentation, its challenges, and the role of the individual provider. In this blog post, we look at steps that healthcare organization leaders can take to help ease the documentation burden on clinicians, maintain team motivation, and ultimately improve the organization’s HCC coding practices and bottom line. Making HCC Coding Easier: Start with the Right Tools Managing the complexities of risk adjustment documentation is difficult without the use of ...

  HCC Coding Technology The New Year brings new opportunities and New Year's resolutions. As a healthcare provider, what are your professional resolutions to drive change and improvement for your practice? This blog post, the third of its series, will focus on an important topic for those providing services to Medicare Advantage patients: using technology to optimize the HCC documentation process and increasing RAF scores. We will talk about recent updates to the CMS-HCC program, as well as retrospective and prospective approaches toward risk adjustment analytics and coding. HCC Coding in 2020 To get started with the topic of HCC Coding technology, let’s talk about some of the reasons why technology is important for your healthcare organization in the new year. One of the primary reasons includes staying up to date with CMS’ extensive policies and regulations. CMS requires that providers have a patient encounter each calendar year, and as mentioned in an article in ICD Monitoring, ...

  In February 2019, the ONC and CMS proposed a new interoperability rule. This interoperability rule would impact patients, providers, and software developers in the industry, as it promises to improve the exchange of data between EHRs and outside applications of the patient’s or provider’s selection. To sum it up, the interoperability rule as mentioned in Health IT will “support seamless and secure access, exchange, and use of electronic health information (EHI). It calls on the healthcare industry to adopt standardized application programming interfaces (APIs), which will help allow individuals to securely and easily access structured EHI using smartphone applications”. Earlier in 2019, we posted about our thoughts on the interoperability rule, mentioning some of the benefits it would bring once implemented: The rule would encourage developers to come up with applications that enable providers to up their clinical game. It will facilitate the free exchange of data between healthc...

While you are working on your patient’s chart, the HCC Assistant automatically analyzes the clinical information in the background and starts preparing HCC coding suggestions to display within the patient’s chart. Once the HCC Assistant’s analysis is completed, you can review the suggested HCC codes displayed at the point of care, select the ones you want to document, and easily submit them back to the EHR in a couple of clicks.  

  On March 6, congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. This new rule allows healthcare providers to bill Medicare fee-for-service for patient care by Telehealth during the current coronavirus pandemic crisis. This legislation allows the U.S. Department of Health and Human Services (HHS) secretary the authority to waive or modify certain Telehealth Medicare requirements when the President has declared a National Emergency. It also expands coverage on Telehealth services provided by audio and video interaction between the provider and the covered patient. CMS has clarified that the established-relationship rule will not be enforced and mentions “The patient must initiate the service and give consent to be treated virtually, and the consent must be documented in the medical record before initiation of the service”. Also, enrollees in Medicare Advantage plans may be able to receive clinically appropriate services via Telehealth from the...

The pandemic presented many challenges over the past year, including stay-at-home orders that hindered access to healthcare. During the first half of 2020, many providers’ offices closed to all appointments except emergencies, which delayed routine and preventive care for millions of people. Statistics from the end of 2020 show that prospective risk scores used to pay Medicare Advantage (MA) health plans are trending lower than forecasted. According to a study by Avalere, “deferral of care during the COVID-19 pandemic is resulting in fewer claims and diagnoses among Medicare Advantage (MA) enrollees, which could lead to a 3%–7% reduction in 2021 risk scores and lower plan payments in 2021”. The increase in deferral of care might change drastically this year as the pandemic is subsiding and vaccine rollout continues. While we did see a huge reduction last year, health plans and providers now are starting to see an increase in demand for elective and routine care. Still, according to ris...

How often do you monitor and audit the accuracy of your HCC Coding? In past blog posts, we’ve talked about the importance of HCC Coding & accurate risk adjustment documentation. In today’s blog, we will provide you with valuable information about how to take your HCC coding & risk adjustment to the next level with M.E.A.T. criteria auditing. As a provider, you understand the importance of HCC Coding. You probably spend a good amount of time making sure you add the correct HCC codes to your documentation, and staying up to date with adequate supporting documentation for HCC codes – all this to decrease your risk of lower payments, audits, and financial penalties. To document accurately, and make this process easier, healthcare organizations use M.E.A.T. criteria standards. Following M.E.A.T. criteria standards ensures healthcare provider organizations, coding companies, practice management consultants, and revenue cycle companies regularly monitor and audit for correct HCC codin...

  As enrollment in Medicare Advantage plans grows, healthcare organizations need to be able to predict future healthcare financial resources and appropriate reimbursement. The Hierarchical Condition Category (HCC) risk adjustment model is used by CMS to estimate predicted costs for Medicare Advantage beneficiaries, and the results directly impact the reimbursement healthcare organizations receive. CMS uses the CMS–hierarchical condition category (CMS– HCC) model to risk-adjust MA payments. This model uses beneficiaries’ demographic information and diagnosed medical conditions gathered into hierarchical condition categories (HCCs) to predict their costliness. Many organizations today struggle to achieve optimal documentation that will help them increase RAF scores and funding from medicare advantage contracts. Having a successful strategy implemented to improve HCC medicare risk adjustment scores for your practice can help reduce underpayments, enhance the quality of care and impro...