A hot topic in healthcare right now, especially in the medical coding world is the Hierarchical Condition Category (HCC) risk adjustment model and how accurate coding affects healthcare organizations’ reimbursement.
With almost one third of Medicare beneficiaries enrolled in Medicare Advantage plans, it’s more important than ever for healthcare organizations to pay attention to this model and make sure physicians are coding diagnoses appropriately to ensure fair compensation. This article walks through basics of the risk adjustment model, why coding accuracy is so important, and five action items for interdisciplinary work groups to take. They include:
Having an accurate problem list.
Ensuring patients are seen in each calendar year.
Improving decision support and EMR optimization.
Widespread education and communication.
Tracking performance and identifying opportunities.
Risk adjustment documentation and coding overviewScott Quick
A collection of information from publicly available sources to help you:
• Know what Risk Adjustment (RA) is and why it is important to Medicare Advantage providers
• Understand Hierarchical Condition Categories (HCCs)
• Become familiar with Risk Adjustment Documentation and Coding Requirements
The document discusses creating a value-based healthcare system focused on patient outcomes and costs. It recommends organizing multidisciplinary teams around patient conditions, measuring outcomes and costs by condition, and developing bundled payments to compensate providers for treating a condition over the full cycle of care. The document also provides an example of Martini Klinik in Germany, which achieves better prostate cancer outcomes than average hospitals through dedicated teams, extensive outcomes tracking, and peer comparison.
Are you:
Keeping up to date with your risk scoring?
Missing out on reimbursement premiums?
Ensuring accurate health profiles for your patients?
Proper risk adjustment is important, not only to ensure your patients' quality of care, but also to improve your bottom line. This CareOptimize presentation will take you from the basic tenets of risk adjustment to specific ways you can increase your risk scores and get the highest premium payments.
Payment posting in RCM seems like an afterthought, something that happens after the “real” work of medical billing ends. After all, you’ve done the hard part and got the payments in the door. Payment Posting is the crucial step in the Revenue Cycle Management process.
Healthcare Billing and Reimbursement: Starting from ScratchDale Sanders
The healthcare billing environment in the US is a disaster. It creates huge waste in care and cost. As presented at the Cayman Islands International Healthcare Conference in October 2010, this slide deck suggests what the billing system might look like, if we could start over.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
Healthcare Industry Highlight: Revenue Cycle ManagementCascadia_Capital
In our most recent Healthcare Industry Highlight Report on Revenue Cycle Management, we outline the trends driving consolidation and increased market activity and make predictions on the outlook and future of the RCM ecosystem.
Dubai health insurance adjudication manual v1.0 finaldrrskhan
This document provides guidance on adjudicating claims for Dubai Health Insurance according to standardized rules. It outlines rules for submitting and updating DRG codes, splitting payments between insurers if coverage changes, billing for transfer cases between hospitals, including discharge medication and surgical kits in payments, excluding non-covered services, and billing for suites, patient hoteling, community physicians, and send-out services. The purpose is to correctly and consistently adjudicate claims according to these rules.
Risk adjustment documentation and coding overviewScott Quick
A collection of information from publicly available sources to help you:
• Know what Risk Adjustment (RA) is and why it is important to Medicare Advantage providers
• Understand Hierarchical Condition Categories (HCCs)
• Become familiar with Risk Adjustment Documentation and Coding Requirements
The document discusses creating a value-based healthcare system focused on patient outcomes and costs. It recommends organizing multidisciplinary teams around patient conditions, measuring outcomes and costs by condition, and developing bundled payments to compensate providers for treating a condition over the full cycle of care. The document also provides an example of Martini Klinik in Germany, which achieves better prostate cancer outcomes than average hospitals through dedicated teams, extensive outcomes tracking, and peer comparison.
Are you:
Keeping up to date with your risk scoring?
Missing out on reimbursement premiums?
Ensuring accurate health profiles for your patients?
Proper risk adjustment is important, not only to ensure your patients' quality of care, but also to improve your bottom line. This CareOptimize presentation will take you from the basic tenets of risk adjustment to specific ways you can increase your risk scores and get the highest premium payments.
Payment posting in RCM seems like an afterthought, something that happens after the “real” work of medical billing ends. After all, you’ve done the hard part and got the payments in the door. Payment Posting is the crucial step in the Revenue Cycle Management process.
Healthcare Billing and Reimbursement: Starting from ScratchDale Sanders
The healthcare billing environment in the US is a disaster. It creates huge waste in care and cost. As presented at the Cayman Islands International Healthcare Conference in October 2010, this slide deck suggests what the billing system might look like, if we could start over.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
Healthcare Industry Highlight: Revenue Cycle ManagementCascadia_Capital
In our most recent Healthcare Industry Highlight Report on Revenue Cycle Management, we outline the trends driving consolidation and increased market activity and make predictions on the outlook and future of the RCM ecosystem.
Dubai health insurance adjudication manual v1.0 finaldrrskhan
This document provides guidance on adjudicating claims for Dubai Health Insurance according to standardized rules. It outlines rules for submitting and updating DRG codes, splitting payments between insurers if coverage changes, billing for transfer cases between hospitals, including discharge medication and surgical kits in payments, excluding non-covered services, and billing for suites, patient hoteling, community physicians, and send-out services. The purpose is to correctly and consistently adjudicate claims according to these rules.
Introduction to Joint Commission International (JCI) - Dr Amrish Kamboj - Dir...Amrish Kamboj
This document provides an overview of the Joint Commission International (JCI) including its mission, organizational structure, history, standards development process, accreditation programs, and the impact of accreditation. The key points are:
1) JCI's mission is to improve safety and quality of care internationally through education, publications, consultation and evaluation services.
2) It is a division of Joint Commission Resources which is a non-profit affiliate of The Joint Commission.
3) JCI has accredited over 40 hospitals internationally and developed standards for laboratories, medical transport and other areas.
4) Accreditation aims to stimulate continuous quality improvement and reduces risks through the use of consensus-based, measurable standards.
This document compares fee-for-service and capitation payment models in healthcare. It describes how fee-for-service may promote overutilization by not incentivizing preventative care and placing financial risk on payers. Capitation pays providers a flat monthly rate per patient, incentivizing preventative care and quality over quantity to keep costs low by placing financial risk on providers. While capitation aims to control costs and encourage value-based care, its long-term success requires payment rates remain high enough for provider participation.
The document discusses strategies for promoting international medical tourism to India, noting that cardiac treatment and orthopedics are the most popular services. It outlines the major sources of international patients, including from SAARC countries, Africa, and the United States. The document also provides an overview of the business model and processes involved in facilitating medical tourism, from initial information gathering to finalizing travel plans.
Patient satisfaction & quality in health care (13.3.2017) dr.nyunt nyunt waiMmedsc Hahm
This document discusses patient satisfaction and quality in healthcare. It defines patient satisfaction as the degree to which patients regard healthcare services as useful, effective or beneficial. Patient satisfaction is important for public accountability and quality improvement at both the system and individual provider levels. The document outlines factors that influence patient satisfaction, including the quality and competency of providers, effectiveness and appropriateness of care, and interpersonal relationships. It also discusses the rights of patients and needs of providers in a client-centered healthcare model.
The document discusses a case study conducted at Apollo Hospital in Ahmedabad on the Third Party Administrator (TPA) process. It aims to understand the admission and discharge processes for TPA patients and identify reasons for delays. The study found that discharging a TPA patient takes 4-6 hours on average. Key causes of delay included incomplete discharge summaries, billing issues, consultant availability, and delayed approvals from the TPA. Recommendations to address the delays included improving pre-authorization forms, planning admissions and discharges, adding more staff to the TPA desk, and educating patients on the TPA process.
AI and the Future of Healthcare, Siemens HealthineersLevi Shapiro
Presentation by Joanne Grau, Head of Digitalization Thought-Leadership at Siemens Healthineers, Oct 31, 2022, for mHealth Israel- "AI and the Future of Healthcare". Three sections- Workforce Productivity, Precision Therapy and Digital Twin.
This document provides an overview of Medicare, including:
- Parts A and B which cover hospital insurance and medical insurance. Part C includes Medicare Advantage Plans and Part D covers prescription drug coverage.
- Original Medicare and Medicare Advantage Plans (like HMOs and PPOs) are choices for coverage. Extra help is available for those with limited income.
- Eligibility, enrollment periods, premiums, deductibles, and cost sharing are explained for different parts and plan options. Programs like Medicaid and Medicare Savings Programs also help cover costs.
Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.DR. S A HAMIDI
The document provides background information on a study about patient satisfaction levels at tertiary level hospitals in Dhaka City, Bangladesh. It outlines the study objectives which are to assess and compare patient satisfaction levels regarding hospital services and identify other factors influencing satisfaction. The methodology section describes the study design as cross-sectional, conducted from May to December 2015 at Holy Family Red Crescent Medical College Hospital. A sample of 170 admitted medicine patients was surveyed using purposive sampling and structured questionnaires. Preliminary results on patient demographics and satisfaction with hospital reception are presented.
JCI is a non-profit organization that accredits healthcare facilities outside of the United States. It was founded in the late 1990s and currently accredits over 375 facilities across 47 countries. JCI has a global team of over 200 consultants and surveyors. It provides accreditation for various types of healthcare organizations. The 5th edition of JCI standards will take effect in 2014 and contains 285 standards across four sections relating to accreditation requirements, patient care, organizational management, and academic medical centers. JCI uses a thorough survey methodology including document review, mock surveys, and multi-day onsite surveys where surveyors follow patient cases and processes. Facilities must meet minimum scoring thresholds on standards and chapters to receive ac
The document discusses improving staff compliance with Medicare guidelines for charting patient discharges at a hospital. It analyzes the current discharge documentation process, finds deficiencies, implements solutions such as discharge education and tracking systems, and re-measures improvements. Process errors were reduced by over 50% and statistical tests showed the improved process was in control and significantly better than before.
Patient Loyalty: What it Takes to Earn Their Loyalty Sallie Burnett
The document discusses strategies for earning patient loyalty in healthcare. It defines loyalty and distinguishes it from satisfaction. Loyalty is built on satisfaction over multiple interactions that generate value. Earning recommendations is more important for healthcare providers than other industries due to influence on choices, but healthcare lags in customer service and loyalty. The 7 best practices outlined for building patient loyalty include quantifying loyalty economics, segmenting customers, improving digital experiences, cementing value relationships, and enabling referrals.
Accounts Receivable & Denial Management Services - Nursing HomeMichael Smith
Sun Knowledge provides accounts receivable follow-up and denial management services for nursing homes. They utilize a team of skilled staff to conduct claims follow-ups, address denied claims, and work to resolve unpaid balances. Their process involves identifying unpaid claims, determining the reason for non-payment, correcting issues, resubmitting claims, appealing denials, and billing patients when necessary. Some challenges they face include understanding complex billing rules and obtaining needed documentation, but they address these through initiatives like researching exceptions, following up on claims regularly, and checking older claims to identify trends.
The document provides a business plan for a proposed Community Health Clinic (CHC) operated by 2BWell, Inc. The plan outlines the problem of needing to increase patient volume at the current clinic to become self-sustaining. It then analyzes the target market, competitors, and identifies opportunities to increase revenue and reduce costs for the CHC, including maintaining the status quo, establishing an associateship practice for recent graduates, donating space to a local naturopathic college, operating the CHC on Saturdays, or integrating CHC patients into the private practice. Financial projections are provided for several of the opportunities. The overall goal is for the CHC to operate independently from 2BWell and be financially self-
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
This document is a health insurance claim form for Blue Cross Blue Shield of Illinois. It provides instructions for completing the form to submit a claim for health insurance reimbursement. It notes that providing false information is fraudulent. It requests information about the patient, primary policy holder, and any other applicable insurance. It also provides examples of the type of information and documentation needed for different types of medical bills to ensure proper processing and reimbursement of claims.
This document outlines a lecture on patient-centered care. It begins with defining patient-centered care as organizing healthcare around the patient's needs and preferences. It then discusses the benefits of implementing patient-centered care such as improved outcomes, satisfaction, and cost-effectiveness. The document also covers factors that contribute to patient-centered care like leadership support, technology to engage patients, and strategies for implementation like training and policies that promote continuity of care. Barriers to implementation include resistance to change and lack of clarity on initiating culture change. The role of nurses is also emphasized as most significant in daily patient-centered care delivery and implementation.
Patient Satisfaction deals with how patients evaluate the quality of their healthcare experience. It is mainly assessed by conducting Patient Satisfaction Surveys using Healthcare Survey Software to determine the high quality of care, in addition to numerous other dimensions of quality, such as relevance to need, effectiveness, and efficiency.
Sally Harris evaluated the effectiveness of her microteaching session on the difference between customer experience and customer service. She began with a strong presence and checked learners' well-being and engagement. Harris introduced her aims and objectives clearly using various resources like video and role-playing. Feedback indicated making the emotions task less open-ended and allowing more time. Her development path includes short-term adjustments based on feedback and long-term focus on context and key areas to better embed knowledge.
HCC Coding Infographic: Critical Element of Risk ManagementPYA, P.C.
Inaccurate HCC coding can lead to significant financial implications and variability in Risk Adjustment Factor scores. A new infographic released by PYA illustrates why coding accuracy is paramount and how implementing a best practice HCC “periodic checkup” is essential to the solution.
HCC Coding and Risk Adjustment Tool model is specially designed to estimate future health care costs for patients. its main objective is to consider the well-being of the executives alongside exact repayments from medicare Advantage Plans.
ACOs: Four Ways Technology Contributes to SuccessHealth Catalyst
With an increasing emphasis on value-based care, Accountable Care Organizations (ACOs) are here to stay. In an ACO, healthcare providers and hospitals come together with the shared goals of reducing costs and increasing patient satisfaction by providing high-quality coordinated healthcare to Medicare patients. However, many ACOs lack direction and experience difficulty understanding how to use data to improve care. Implementing a robust data analytics system to automate the process of data gathering and analysis as well as aligning data with ACO quality reporting measures. The article walks through four keys to effectively implementing technology for ACO success:
Build a data repository with an analytics platform.
Bring data to the point of care.
Analyze claims data, identify outliers, including successes and failures.
Combine clinical claims, and quality data to identify opportunities for improvement.
Introduction to Joint Commission International (JCI) - Dr Amrish Kamboj - Dir...Amrish Kamboj
This document provides an overview of the Joint Commission International (JCI) including its mission, organizational structure, history, standards development process, accreditation programs, and the impact of accreditation. The key points are:
1) JCI's mission is to improve safety and quality of care internationally through education, publications, consultation and evaluation services.
2) It is a division of Joint Commission Resources which is a non-profit affiliate of The Joint Commission.
3) JCI has accredited over 40 hospitals internationally and developed standards for laboratories, medical transport and other areas.
4) Accreditation aims to stimulate continuous quality improvement and reduces risks through the use of consensus-based, measurable standards.
This document compares fee-for-service and capitation payment models in healthcare. It describes how fee-for-service may promote overutilization by not incentivizing preventative care and placing financial risk on payers. Capitation pays providers a flat monthly rate per patient, incentivizing preventative care and quality over quantity to keep costs low by placing financial risk on providers. While capitation aims to control costs and encourage value-based care, its long-term success requires payment rates remain high enough for provider participation.
The document discusses strategies for promoting international medical tourism to India, noting that cardiac treatment and orthopedics are the most popular services. It outlines the major sources of international patients, including from SAARC countries, Africa, and the United States. The document also provides an overview of the business model and processes involved in facilitating medical tourism, from initial information gathering to finalizing travel plans.
Patient satisfaction & quality in health care (13.3.2017) dr.nyunt nyunt waiMmedsc Hahm
This document discusses patient satisfaction and quality in healthcare. It defines patient satisfaction as the degree to which patients regard healthcare services as useful, effective or beneficial. Patient satisfaction is important for public accountability and quality improvement at both the system and individual provider levels. The document outlines factors that influence patient satisfaction, including the quality and competency of providers, effectiveness and appropriateness of care, and interpersonal relationships. It also discusses the rights of patients and needs of providers in a client-centered healthcare model.
The document discusses a case study conducted at Apollo Hospital in Ahmedabad on the Third Party Administrator (TPA) process. It aims to understand the admission and discharge processes for TPA patients and identify reasons for delays. The study found that discharging a TPA patient takes 4-6 hours on average. Key causes of delay included incomplete discharge summaries, billing issues, consultant availability, and delayed approvals from the TPA. Recommendations to address the delays included improving pre-authorization forms, planning admissions and discharges, adding more staff to the TPA desk, and educating patients on the TPA process.
AI and the Future of Healthcare, Siemens HealthineersLevi Shapiro
Presentation by Joanne Grau, Head of Digitalization Thought-Leadership at Siemens Healthineers, Oct 31, 2022, for mHealth Israel- "AI and the Future of Healthcare". Three sections- Workforce Productivity, Precision Therapy and Digital Twin.
This document provides an overview of Medicare, including:
- Parts A and B which cover hospital insurance and medical insurance. Part C includes Medicare Advantage Plans and Part D covers prescription drug coverage.
- Original Medicare and Medicare Advantage Plans (like HMOs and PPOs) are choices for coverage. Extra help is available for those with limited income.
- Eligibility, enrollment periods, premiums, deductibles, and cost sharing are explained for different parts and plan options. Programs like Medicaid and Medicare Savings Programs also help cover costs.
Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.DR. S A HAMIDI
The document provides background information on a study about patient satisfaction levels at tertiary level hospitals in Dhaka City, Bangladesh. It outlines the study objectives which are to assess and compare patient satisfaction levels regarding hospital services and identify other factors influencing satisfaction. The methodology section describes the study design as cross-sectional, conducted from May to December 2015 at Holy Family Red Crescent Medical College Hospital. A sample of 170 admitted medicine patients was surveyed using purposive sampling and structured questionnaires. Preliminary results on patient demographics and satisfaction with hospital reception are presented.
JCI is a non-profit organization that accredits healthcare facilities outside of the United States. It was founded in the late 1990s and currently accredits over 375 facilities across 47 countries. JCI has a global team of over 200 consultants and surveyors. It provides accreditation for various types of healthcare organizations. The 5th edition of JCI standards will take effect in 2014 and contains 285 standards across four sections relating to accreditation requirements, patient care, organizational management, and academic medical centers. JCI uses a thorough survey methodology including document review, mock surveys, and multi-day onsite surveys where surveyors follow patient cases and processes. Facilities must meet minimum scoring thresholds on standards and chapters to receive ac
The document discusses improving staff compliance with Medicare guidelines for charting patient discharges at a hospital. It analyzes the current discharge documentation process, finds deficiencies, implements solutions such as discharge education and tracking systems, and re-measures improvements. Process errors were reduced by over 50% and statistical tests showed the improved process was in control and significantly better than before.
Patient Loyalty: What it Takes to Earn Their Loyalty Sallie Burnett
The document discusses strategies for earning patient loyalty in healthcare. It defines loyalty and distinguishes it from satisfaction. Loyalty is built on satisfaction over multiple interactions that generate value. Earning recommendations is more important for healthcare providers than other industries due to influence on choices, but healthcare lags in customer service and loyalty. The 7 best practices outlined for building patient loyalty include quantifying loyalty economics, segmenting customers, improving digital experiences, cementing value relationships, and enabling referrals.
Accounts Receivable & Denial Management Services - Nursing HomeMichael Smith
Sun Knowledge provides accounts receivable follow-up and denial management services for nursing homes. They utilize a team of skilled staff to conduct claims follow-ups, address denied claims, and work to resolve unpaid balances. Their process involves identifying unpaid claims, determining the reason for non-payment, correcting issues, resubmitting claims, appealing denials, and billing patients when necessary. Some challenges they face include understanding complex billing rules and obtaining needed documentation, but they address these through initiatives like researching exceptions, following up on claims regularly, and checking older claims to identify trends.
The document provides a business plan for a proposed Community Health Clinic (CHC) operated by 2BWell, Inc. The plan outlines the problem of needing to increase patient volume at the current clinic to become self-sustaining. It then analyzes the target market, competitors, and identifies opportunities to increase revenue and reduce costs for the CHC, including maintaining the status quo, establishing an associateship practice for recent graduates, donating space to a local naturopathic college, operating the CHC on Saturdays, or integrating CHC patients into the private practice. Financial projections are provided for several of the opportunities. The overall goal is for the CHC to operate independently from 2BWell and be financially self-
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
This document is a health insurance claim form for Blue Cross Blue Shield of Illinois. It provides instructions for completing the form to submit a claim for health insurance reimbursement. It notes that providing false information is fraudulent. It requests information about the patient, primary policy holder, and any other applicable insurance. It also provides examples of the type of information and documentation needed for different types of medical bills to ensure proper processing and reimbursement of claims.
This document outlines a lecture on patient-centered care. It begins with defining patient-centered care as organizing healthcare around the patient's needs and preferences. It then discusses the benefits of implementing patient-centered care such as improved outcomes, satisfaction, and cost-effectiveness. The document also covers factors that contribute to patient-centered care like leadership support, technology to engage patients, and strategies for implementation like training and policies that promote continuity of care. Barriers to implementation include resistance to change and lack of clarity on initiating culture change. The role of nurses is also emphasized as most significant in daily patient-centered care delivery and implementation.
Patient Satisfaction deals with how patients evaluate the quality of their healthcare experience. It is mainly assessed by conducting Patient Satisfaction Surveys using Healthcare Survey Software to determine the high quality of care, in addition to numerous other dimensions of quality, such as relevance to need, effectiveness, and efficiency.
Sally Harris evaluated the effectiveness of her microteaching session on the difference between customer experience and customer service. She began with a strong presence and checked learners' well-being and engagement. Harris introduced her aims and objectives clearly using various resources like video and role-playing. Feedback indicated making the emotions task less open-ended and allowing more time. Her development path includes short-term adjustments based on feedback and long-term focus on context and key areas to better embed knowledge.
HCC Coding Infographic: Critical Element of Risk ManagementPYA, P.C.
Inaccurate HCC coding can lead to significant financial implications and variability in Risk Adjustment Factor scores. A new infographic released by PYA illustrates why coding accuracy is paramount and how implementing a best practice HCC “periodic checkup” is essential to the solution.
HCC Coding and Risk Adjustment Tool model is specially designed to estimate future health care costs for patients. its main objective is to consider the well-being of the executives alongside exact repayments from medicare Advantage Plans.
ACOs: Four Ways Technology Contributes to SuccessHealth Catalyst
With an increasing emphasis on value-based care, Accountable Care Organizations (ACOs) are here to stay. In an ACO, healthcare providers and hospitals come together with the shared goals of reducing costs and increasing patient satisfaction by providing high-quality coordinated healthcare to Medicare patients. However, many ACOs lack direction and experience difficulty understanding how to use data to improve care. Implementing a robust data analytics system to automate the process of data gathering and analysis as well as aligning data with ACO quality reporting measures. The article walks through four keys to effectively implementing technology for ACO success:
Build a data repository with an analytics platform.
Bring data to the point of care.
Analyze claims data, identify outliers, including successes and failures.
Combine clinical claims, and quality data to identify opportunities for improvement.
The Changing Role of the Provider in HCC CodingInferscience
Inferscience offers an HCC Coding tool that integrates with leading EHRs and HIT systems to analyze patient records and claims information to help physicians and coders capture and audit HCC codes within their workflows. This PDF will give detailed information about The Changing Role of the Provider in HCC Coding. With Inferscience’s HCC Assistant, Physicians can document HCC codes and plan of care information in real time during the patient encounter. Now, one solution enables both payers and providers to succeed in today’s value-based care market. For more detail about our services, please visit our website now!
The Healthcare Quality Coalition wrote to CMS Administrator Berwick to provide feedback on the proposed Medicare Shared Savings Program and ACO regulations. The coalition supports the goals of improved care coordination and reduced costs through alternative payment models like ACOs. However, the letter outlines several concerns with the proposed rule, including that it requires reporting on too many quality measures in year one, does not adequately account for patient acuity, and may not provide sufficient incentives for high-quality organizations to participate. The coalition urges CMS to address these issues in the final rule.
This document provides an overview of Synergetics' "Industry in Focus" series highlighting trends in the healthcare and life sciences industry and how Synergetics is positioned to help clients in this sector. It discusses the challenges facing third party administrators in healthcare, including balancing costs and provider reimbursement rates. It also identifies factors driving increasing healthcare costs and provides examples of ways Synergetics has helped healthcare clients improve efficiency and profitability through process improvements and technology optimization.
Impact on Health Reform on Device Development and FundingUBMCanon
The document discusses the impact of US healthcare reform on medical device development and funding. It summarizes that healthcare reform through the Affordable Care Act and other policies is driving major changes in health insurance purchasing and moving payments from fee-for-service to bundled payments and accountable care organizations. This shift to alternative payment models will require device manufacturers to understand how provider reimbursement is changing to ensure their devices provide value within the new systems.
150228 Should ACO's Attract the Sick v1.8Orry Jacobs
This document discusses whether Medicare Advantage plans should try to attract sicker patients. It argues that with improved care coordination, risk adjustment models, and predictive analytics, plans could successfully enroll high-risk populations while saving billions through reduced costs and improved quality of care. Specifically, focusing care management programs on the small portion of beneficiaries who account for a large share of costs could yield savings of up to 20% according to some studies. The document provides examples of how plans could double their revenue and increase profits substantially by enrolling more high-risk patients if effective programs and proper incentives are in place. However, it notes there are challenges to achieving these levels of savings.
The 100-Percent Solution to Improving Healthcare’s Operating MarginsHealth Catalyst
Healthcare organizations face unparalleled pressure to increase operating margins as they adapt to the revenue compression from COVID-19 and growing competition from insurers and digital disrupters. Yet, many health systems rely on outdated, revenue-centric cost accounting solutions that are ill equipped for strategic financial decision making. As a methodology for today’s complex healthcare environment, activity-based costing (ABC) can capture healthcare resource use at a granular level. With this service-level insight into clinical cost, ABC provides actionable intelligence to help organizations improve profitability and make strategic cost-reduction decisions. These comprehensive costing solutions give health systems a full understanding of cost across the care continuum—the only level of insight that will enable strategic cost transformation in the industry’s new normal.
How Physicians Can Prepare for the Financial Impact of MACRAHealth Catalyst
If all goes according to plan, the first performance period for the new Medicare Access and Chip Reauthorization Act (MACRA) is just around the calendar corner. It’s a complicated reimbursement structure with multiple tracks that are guaranteed to reward with bonuses or inflict pain through penalties in CMS’s new zero sum game. To the physicians and practices that adopt this new program early and position themselves for the best fiscal outcomes, go the spoils. But for many smaller practices and those that consistently underperform, the outlook may be glum regardless. Here are some highlights of the new program and the financial impact it will have on clinicians and practices.
Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritiz...Health Catalyst
Today’s healthcare encounters are too often marked by more clinician screen time than patient-clinician engagement. Increasing regulatory reporting burdens are diverting clinician attention from their true priority—the patient. To put patients back at the center of care, CMS introduced its Meaningful Measures framework in 2017. The initiative identifies the highest priorities for quality measurement and improvement, with the goal of aligning measures with CMS strategic goals, including the following:
Empowering patients and clinicians to make decisions about their healthcare.
Supporting innovative approaches to improve quality, safety, accessibility, and affordability.
Value-Based Care (VBC) is crucial due to the soaring healthcare spending in the US, now over $4.4 trillion yearly. Despite this, results remain subpar, with 2-3 times more spent compared to other developed countries.
The document discusses emerging value-based healthcare payment models in the US and provides recommendations for stakeholders. It outlines recent legislation like MACRA that aims to shift Medicare payments from fee-for-service to value-based models. MACRA establishes the MIPS program which combines existing quality programs and the APM program which incentivizes participation in alternative payment models. It also describes various CMS pay-for-performance programs focused on readmissions, hospital value, and hospital-acquired conditions. The document concludes with recommendations for stakeholders to collaborate across the healthcare system to effectively transition to value-based models.
Mastering the Art of Medical Billing: A Comprehensive Guide to Successjwilliamj223
Cigma Medical Coding Academy offers 100% placement gurarantee training and provides No.1 certification program in Medical Coding, Medical Billing & Medical Transcription sourses in Kerala, Kochi, Bangalore, & Mangalore.
An Accountable Care Organization (ACO) is a provider-led organization that manages the full continuum of care for a defined patient population to improve quality and reduce costs. The US healthcare system lacks coordination and incentives for value over volume, motivating ACO development. ACOs differ from 1990s integrated delivery systems by focusing on managing performance risk rather than insurance risk through tools like bundled payments, quality tracking, and health IT. Critical functions include attributing patients, budgeting, performance measurement, and managing payment models to distribute shared savings incentives.
A Clinically Integrated Network (CIN) is a selective partnership of physicians collaborating with
hospital(s) and other providers to deliver evidence-based care, improve quality and efficiency,
manage populations and demonstrate value to the market. Once these objectives are met, the network may contract on behalf of participants
Navigating Challenges in HCC Coding and Risk AdjustmentInferscience
HCC coding processes while not designed to be complex, may not be immediately apparent, making them tedious and time-consuming. Despite its inherent difficulty, the main goal is to provide an accurate and complete overview of each member’s risk profile with the goal of better understanding their health state and being able to predict the cost of care. We also suggest looking into smart HCC Coding and risk adjustment technology, this can help your teams achieve more accurate results and save time. Check out Inferscience’s HCC Assistant to learn more about HCC coding technology that is EHR integrated.
Inferscience offers an add-on product to work with the HCC Assistant, the HCC Validator. The HCC Validator uses advanced NLP technology to instantly validate HCC codes against MEAT criteria and issues a clear “Pass” or “Fail” grade. Because it’s SaaS-based, it works with leading EHRs or can be used as a standalone solution. The New Year brings new opportunities and New Year's resolutions. 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.
1) The payment models in healthcare are shifting from fee-for-service to value-based models that tie reimbursement to quality outcomes and cost savings. This transition is being driven by rising healthcare costs, the Affordable Care Act, and commercial insurers.
2) Providers now need to accelerate preparations for managing clinical and financial risk through value-based contracts. This requires changes to business models, physician alignment, and supporting patients through the transition.
3) For organizations to succeed under value-based contracts, they must define population health strategies, implement coordinated care delivery models, and carefully sequence clinical and financial transformations to capture savings while maintaining stability.
Similar to Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Analytics (20)
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...Health Catalyst
Today’s healthcare leaders are seeking technology solutions to optimize efficiencies and improve patient care. However, without effective change management and strategies in place, healthcare leaders struggle to strategically improve patient flow, space, to strategically improve patient flow, space, and schedule management, and implement daily huddles. The role of technology in supporting operational efficiency and change management initiatives is inevitable.
During this webinar, attendees will learn how to optimize Ambulatory Operational Efficiencies and Change Management. Attendees will also learn about the importance of visual management boards in enhancing clinic performance and insights into effective change management approaches.
Patient expectations are rising, and organizations are continuously being asked to do more with less.
Additionally, the convergence of several significant emerging market and policy trends, economic uncertainty, labor force shortages, and the end of the COVID-19 public health emergency has created a unique set of challenges for healthcare organizations.
Attend this timely webinar to learn about new trends and their impact on key healthcare issues, such as patient engagement, migration to value-based care, analytics adoption, the use of alternative care sites, and data governance and management challenges.
During this webinar, we will discuss the complexities of AI, trends, and platforms in the industry. Dive deep into understanding the true essence of AI, exploring its potential, real-world use cases, and common misconceptions. Gain valuable insights into the latest technology trends impacting healthcare and discover strategies for maximizing ROI in your technology investments.
Explore the profound impact of data literacy on healthcare organizations and how it shapes the utilization of data and technology for transformative outcomes. Understand the top technology priorities for healthcare organizations and learn how to navigate the digital landscape effectively. Furthermore, simplify industry jargon by defining common data elements, fostering clearer communication and collaboration across stakeholders.
Finally, uncover the transformative potentials of platforms in healthcare and how they can revolutionize scalability, interoperability, and innovation within your organization. Don't miss this opportunity to gain invaluable insights from industry experts and stay ahead in the ever-evolving healthcare landscape. Reserve your spot now for an enlightening journey into the future of healthcare technology!
Three Keys to a Successful Margin: Charges, Costs, and LaborHealth Catalyst
How can cost management and complete charge capture protect and enhance the margin?
In this webinar, we will look at 2024 margin pressures likely to impact your organization’s financial resiliency. This presentation will also share how organizations can move from Fee-for-Service to Value; bringing Cost to the forefront.
2024 CPT® Updates (Professional Services Focused) - Part 3Health Catalyst
Each year the CPT code set undergoes significant changes. Physicians and their office staff need to be aware of the changes in order to ensure a smooth transition into 2024. Join us for a discussion of the new, deleted and revised CPT codes and associated guidelines for 2024. This presentation will focus on the changes to the CPT dataset and the associated work RVU value changes that impact professional service reporting.
During this complimentary webinar, we will empower you to correctly apply the new and revised codes and discuss the rationale behind this year’s changes. You will leave with an understanding of the financial implications of the changes on your practice.
2024 CPT® Code Updates (HIM Focused) - Part 2Health Catalyst
Each year the CPT code set and the HCPCS code set undergo significant changes, and your coding staff needs to be aware of the changes in order to ensure a smooth transition into 2024. Join us for a discussion of the new, deleted and revised CPT codes and associated guidelines for 2024. This is part two in a three-part series.
During these complimentary webinars, we will empower you to correctly apply the new and revised codes and discuss the rationale behind this year’s changes. This presentation will be geared towards hospital staff with a focus on the surgical section of the CPT book in addition to surgical Category III codes.
2024 CPT® Code Updates (CDM Focused) - Part 1Health Catalyst
The document provides an overview of changes to CPT codes that will take effect in 2024, with a focus on changes relevant to clinical documentation. Key points include:
- There are 145 total codes added, 34 deleted, and 55 revised across various sections.
- Changes are provided for the Radiology, Laboratory/Pathology, and Category III sections. New codes are added for things like non-invasive coronary FFR estimation using AI and various intraoperative ultrasound exams.
- Guidelines are established for new genomic sequencing procedures codes focusing on solid organ and hematolymphoid neoplasms. Definitions are also provided for various genomic analysis techniques.
- Several Tier I and Tier II molecular
What’s Next for Hospital Price Transparency in 2024 and BeyondHealth Catalyst
The Centers for Medicare & Medicaid Services (CMS) published updates to the hospital price transparency requirements in the CY 2024 Outpatient Prospective Payment System (OPPS) Final Rule. The updates will be phased in over the next 14 months and include several significant changes including the use of a CMS-mandated template, a requirement for an affirmation statement from the hospital, and several new data elements. Join us to discover what changes are scheduled for implementation in 2024 and 2025 and how they’ll impact your facility.
During this complimentary 60-minute webinar, we’ll analyze the key provisions of the Price Transparency regulations and provide insights to help you prepare for the upcoming changes.
Automated Patient Reported Outcomes (PROs) for Hip & Knee ReplacementHealth Catalyst
What was once voluntary reporting will soon be made mandatory with penalties.
On July 1, 2024, all health systems will be required to collect Patient Reported Outcome Measures (PROM) as part of the Centers for Medicare & Medicaid Services (CMS) regulation for the following measures:
Hospital-Level, Risk Standardized Patient-Reported Outcomes Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA)
Hospital-Level Risk-Standardized Complication Rate (RSCR) Following Elective Primary THA/TKA
Are you equipped to handle these new requirements?
Mandatory data collection begins April 1, 2024, and failure to submit timely data can result in a 25 percent reduction in payments by Medicare.
Attend this webinar to learn how mobile engagement can empower your organization to meet this requirement.
2024 Medicare Physician Fee Schedule (MPFS) Final Rule UpdatesHealth Catalyst
According to the Centers for Medicare & Medicaid Services (CMS), the calendar year (CY) 2024 MPFS final rule was created to advance health equity and improve access to affordable healthcare. This webinar will cover the major policy updates of the MPFS final rule including updates to the telehealth services policy and remote monitoring services and enrollment of MFTs and MHCs as Medicare providers. The conversation will also cover policy changes on split (or shared) evaluation and management (E/M) visits, and the Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging.
What's Next for OPPS: A Look at the 2024 Final RuleHealth Catalyst
During this webinar, we’ll analyze the key provisions of the OPPS final rule and identify the significant changes for the coming year to help prepare your staff for compliance with the 2024 Medicare outpatient billing guidelines.
Insight into the 2024 ICD-10 PCS Updates - Part 2Health Catalyst
Three new codes were added to describe procedures involving a short-term external heart assist system inserted into the descending thoracic aorta. Codes were also added for fluorescence guided procedures of the female reproductive system and trunk region using pafolacianine. Additionally, new technology codes were introduced for insertion of intraluminal devices such as venous valves, leadless pacemakers, and artery bypass procedures.
Vitalware Insight Into the 2024 ICD10 CM Updates.pdfHealth Catalyst
This document provides an overview of upcoming changes to ICD-10-CM codes for fiscal year 2024. It notes that there will be 395 new codes, 13 revisions, and 25 deletions. Specific changes include 18 new major complication or comorbidity (MCC) codes, 3 deleted MCC codes, 79 new CC codes, and 8 deleted CC codes. The presentation reviews code additions, deletions, and revisions for various body systems and disease chapters. It also outlines changes to the MCC and CC lists as well as Medicare Severity Diagnosis Related Groups (MS-DRG) updates.
Driving Value: Boosting Clinical Registry Value Using ARMUS SolutionsHealth Catalyst
Many hospitals today face a perfect storm of operational and financial challenges. With increasing competition from outpatient facilities and rising care costs negatively impacting budgets, now is the time to boost your clinical registry’s value. However, collecting and analyzing data can be time-consuming and costly without the right tools. During this webinar, we will share insights and best practices for increasing the value of registry participation and how it’s possible to reduce costs while improving outcomes using the ARMUS Product Suite.
Tech-Enabled Managed Services: Not Your Average OutsourcingHealth Catalyst
The document discusses tech-enabled managed services (TEMS) as an alternative to traditional outsourcing. TEMS aims to reduce costs for health systems while maintaining performance, employees, and culture. It achieves this through specialized partnering, alleviating financial pressures, and ensuring dependable performance using a combination of people, processes, technology, and data. TEMS rebadges existing employees and takes on open positions to prevent workforce reductions. It also maintains existing processes while implementing new technology. This model is said to create wins for Health Catalyst through new employees, the health system through reduced costs and governed performance, and employees through continued work and an improved experience.
This webinar will provide an in-depth review of the CPT/HCPCS code set changes that will be effective on July 1, 2023. The review will include additions and deletions to the CPT/HCPCS code set, revisions of code descriptors, payment changes, and rationale behind the changes.
How Managing Chronic Conditions Is Streamlined with Digital TechnologyHealth Catalyst
Chronic conditions across the United States are prevalent and continue to rise. Managing one or more chronic diseases can be very challenging for patients who may be overwhelmed or confused about their care plan and may not have access to the resources they need. At the same time, care teams are overburdened, making it difficult to provide the support these patients require to stay as healthy as possible. A new approach to chronic condition management leverages technology to enable organizations to scale high-quality care, identify gaps in care, provide personalized support, and monitor patients on an ongoing basis. Such streamlined management will result in better outcomes, reduced costs, and more satisfied patients.
COVID-19: After the Public Health Emergency EndsHealth Catalyst
In this fast-paced webinar, we will discuss the impact of the end of the public health emergency (PHE), including upcoming changes to the different flexibilities allowed during the PHE and the timeline for when these flexibilities will end. We’ll also cover coding changes and reimbursement updates.
Automated Medication Compliance Tools for the Provider and PatientHealth Catalyst
When it comes to sustaining patient health outcomes, compliance and adherence to medication regimens are critically important, especially as providers manage patients with complex care needs and multiple medications. But, with provider burnout and staffing shortages at an all-time high, an efficient solution is critical. The use of automated medication management workflows to decrease provider burnout, while improving both medication compliance and patient engagement, is the way forward.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Get Covid Testing at Fit to Fly PCR TestNX Healthcare
A Fit-to-Fly PCR Test is a crucial service for travelers needing to meet the entry requirements of various countries or airlines. This test involves a polymerase chain reaction (PCR) test for COVID-19, which is considered the gold standard for detecting active infections. At our travel clinic in Leeds, we offer fast and reliable Fit to Fly PCR testing, providing you with an official certificate verifying your negative COVID-19 status. Our process is designed for convenience and accuracy, with quick turnaround times to ensure you receive your results and certificate in time for your departure. Trust our professional and experienced medical team to help you travel safely and compliantly, giving you peace of mind for your journey.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
Map: https://cutt.ly/BwCeflYo
Name: Apollo Hospital
Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
Phone: 08429021957
Opening Hours: 24X7
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator