• Risk adjustment is a critical part of both the financial and clinical aspects of healthcare in the United States. Still, even many people working in healthcare don’t really understand what it is, why it’s important, or how it works. First, what is risk adjustment? Healthcare for approximately 110 million Americans is provided by the US […]

  • As the significance of provider risk adjustment grows, especially within the clinical workflow, finding the right solutions and adopting them in the right order is a critical part of success. Today, I want to discuss that, as well as exploring an unorthodox approach: using pre-encounter risk adjustment strategies that also supports care without burdening physicians […]

  • 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 […]

  • 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 […]

  • Health Fidelity offers conclusions on the flurry of CDC and CMS telehealth policy updates around coding and risk adjustment practices under COVID-19

  • 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.

  • 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. With the Medicare Access and CHIP Reauthorization Act (MACRA) […]

  • 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.

  • Our comprehensive, encounter-centric framework helps providers develop an effective risk capture program to achieve success in value-based care.

  • 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.

  • 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?

  • 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.