• 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 […]

  • 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, […]

  • 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. […]

  • 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.

  • Telemedicine is accelerating, in both adoption and refinement; review the emerging best practices for actionable insights to ensure effective submission and mitigate audit risk.

  • 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.

  • 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 […]

  • 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.