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Flattening the Other Curve: Using Risk Adjustment to Manage Rebounding Patient Volumes
As care patterns continue to shift, and we see new utilization patterns, the stability of capitation and the revenue insulation provided by thorough, effective risk adjustment are key to thriving during uncertain times.
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Accelerating Recovery in Reimbursement for Value-based Care Post COVID-19
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.
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Perspectives on Value-Based Care Post COVID-19
Robin Lloyd, HF Chief Commercial Officer, envisions the longer-term impact on healthcare delivery, policy, and technology following the coronavirus pandemic.
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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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Completeness and Accuracy in Risk Adjustment
In mid-December, the Health and Human Services Office of the Inspector General (HHS-OIG) announced that an investigation into Medicare Advantage organizations (MAO) had found $6.7 billion in potentially unsupported risk adjustment payments, generated from chart review programs that overwhelmingly yielded additional diagnoses. The study further found that 99% of chart reviews resulted in added diagnoses—not […]
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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. With the Medicare Access and CHIP Reauthorization Act (MACRA) […]
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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: The Path to Accurate and Complete Risk Capture
As providers take on increasing levels of risk, they need to understand the maturity of their processes, the workflows they need to optimize, and the levers they can pull to improve their risk adjustment outcomes. Find out how our risk capture maturity model can help you plan your improvement path forward.
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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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Value-Based Care is Here to Stay: The Importance of Risk Adjustment To Provider Performance
The shift from fee-for-service to value-based care is changing not only how patients are cared for, but also how providers are measured and compensated for performance.
Tag: Value-Based Care
Risk Adjustment’s Role in Value-Based Care
The transition from fee-for-service to value-based care is not only changing how patients are cared for, but also how providers are measured and compensated for performance, and risk adjustment is a key component to the financial success of risk-sharing arrangements.