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.
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.
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
HCC coding success is hugely dependent on how accurately and timely data is captured. It also depends on the proper tracking of a patient’s care and condition over a certain period of time.
Are you afraid to encounter CMS & HHS RADV Audit risks? Stop worrying. Here is your guide to risk adjustment. Risk adjustment strategy revealed by subject Matter Experts Holly cassano and Kim Dues. You have got everything here. Data review to analysis , guidelines, formula, best practices and more. Come let's take a closer look https://goo.gl/fVQzet
Medical coding is the process of transforming transcribed data into set of numerical codes using a system of numbers to represent various medical problems, (diagnoses), and treatments (procedures
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.
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
HCC coding success is hugely dependent on how accurately and timely data is captured. It also depends on the proper tracking of a patient’s care and condition over a certain period of time.
Are you afraid to encounter CMS & HHS RADV Audit risks? Stop worrying. Here is your guide to risk adjustment. Risk adjustment strategy revealed by subject Matter Experts Holly cassano and Kim Dues. You have got everything here. Data review to analysis , guidelines, formula, best practices and more. Come let's take a closer look https://goo.gl/fVQzet
Medical coding is the process of transforming transcribed data into set of numerical codes using a system of numbers to represent various medical problems, (diagnoses), and treatments (procedures
Comprehensive Medical Coding and Billing Training for the AAPC CPC Exam. Online Training with videos and Skype sessions. HIPAA Training included along with Medical Billing. Trainer is Dr Guptha, world record holder.
The Differences Between ICD-9 and ICD-10 by Dr.Mahboob ali khan Phd Healthcare consultant
The ICD-10 code sets are not a simple update of the ICD-9 code set. The ICD-10 code sets have fundamental changes in structure and concepts that make them very different from ICD-9. Because of these differences, it is important to develop a preliminary understanding of the changes from ICD-9 to ICD-10. This basic understanding of the differences will then identify more detailed training that will be needed to appropriately use the ICD-10 code sets. In addition, seeing the differences between the code sets will raise awareness of the complexities of converting to the ICD-10 codes.
Clinical Documentation Guidelines for ICD-10-CMPamela Marasco
How Do You Rate Yourself as an Adopter of Change? Assess your willingness to implement new clinical documentation standards for ICD-10-CM. Improve your practice for clinical documentation to ensure proper selection of ICD-10-CM Coding Guidelines. Because EVERYTHING IS CHANGING!
Kanoe India Healthcare, A division Of Kanoe Softwares proposes a special Medical insurance plan sponsored by Universal Sompo General insurance Co. Limited in joint venture with Allahabad Bank Limited, Indian Overseas Bank, Karnataka Bank Limited, Dabur Investments Corp and Sompo Japan Insurance Incorporation in Public Private Partnership (PPP), aiming to provide assurance of Government/Public sector and superb, hassle free service from private bodies.
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.
Vitalware Insight Into the 2024 ICD10 CM Updates.pdfHealth Catalyst
Prepare for mandatory ICD-10 CM diagnosis code updates, which take effect on October 1, 2023. By attending this 60-minute educational session, medical coders and healthcare professionals will gain a comprehensive understanding of the changes to the 2024 ICD-10 diagnosis codes and their guidelines, along with major complication or comorbidity (MCC), complication or comorbidity (CC), and Medicare Severity Diagnosis Related Groups (MS-DRGs) classification changes. With this information, professionals can ensure accurate and compliant diagnosis coding for optimal billing and reimbursement.
ICD-10 Presentation Takes Coding to New HeightsPYA, P.C.
PYA Staff Consultant Kim-Marie Walker updated physicians at Robins Air Force Base on the latest in ICD-10 as part of “Soaring Together: A Collaboration in Continuing Medical Education."
The Top 9 Questions Every Medical Coder Asks about Risk Adjustment and the CR...Laureen Jandroep
The Top 9 Questions Every Medical Coder Asks About Risk Adjustment and the CRC™ Certification was presented in a webinar by Certification Coaching Org (CCO), www.cco.us. A wealth of information was covered including: what Risk Adjustment (RA) entails, how this field is growing, and RA career opportunities. Also discussed was what to look for in a Risk Adjustment course. Attendees’ questions on careers in RA or preparing for the Certified Risk Adjustment Coder (CRC™) credentialing examination were answered. Presenters were Alicia Scott, CPC, CPC-I, CRC, and Chandra Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPC-I, CCS, CANPC, CEMC, CFPC, CIMC, CGSC, COSC, CRC, CCC. The host for the webinar was Boyd Staszewski.
Comprehensive Medical Coding and Billing Training for the AAPC CPC Exam. Online Training with videos and Skype sessions. HIPAA Training included along with Medical Billing. Trainer is Dr Guptha, world record holder.
The Differences Between ICD-9 and ICD-10 by Dr.Mahboob ali khan Phd Healthcare consultant
The ICD-10 code sets are not a simple update of the ICD-9 code set. The ICD-10 code sets have fundamental changes in structure and concepts that make them very different from ICD-9. Because of these differences, it is important to develop a preliminary understanding of the changes from ICD-9 to ICD-10. This basic understanding of the differences will then identify more detailed training that will be needed to appropriately use the ICD-10 code sets. In addition, seeing the differences between the code sets will raise awareness of the complexities of converting to the ICD-10 codes.
Clinical Documentation Guidelines for ICD-10-CMPamela Marasco
How Do You Rate Yourself as an Adopter of Change? Assess your willingness to implement new clinical documentation standards for ICD-10-CM. Improve your practice for clinical documentation to ensure proper selection of ICD-10-CM Coding Guidelines. Because EVERYTHING IS CHANGING!
Kanoe India Healthcare, A division Of Kanoe Softwares proposes a special Medical insurance plan sponsored by Universal Sompo General insurance Co. Limited in joint venture with Allahabad Bank Limited, Indian Overseas Bank, Karnataka Bank Limited, Dabur Investments Corp and Sompo Japan Insurance Incorporation in Public Private Partnership (PPP), aiming to provide assurance of Government/Public sector and superb, hassle free service from private bodies.
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.
Vitalware Insight Into the 2024 ICD10 CM Updates.pdfHealth Catalyst
Prepare for mandatory ICD-10 CM diagnosis code updates, which take effect on October 1, 2023. By attending this 60-minute educational session, medical coders and healthcare professionals will gain a comprehensive understanding of the changes to the 2024 ICD-10 diagnosis codes and their guidelines, along with major complication or comorbidity (MCC), complication or comorbidity (CC), and Medicare Severity Diagnosis Related Groups (MS-DRGs) classification changes. With this information, professionals can ensure accurate and compliant diagnosis coding for optimal billing and reimbursement.
ICD-10 Presentation Takes Coding to New HeightsPYA, P.C.
PYA Staff Consultant Kim-Marie Walker updated physicians at Robins Air Force Base on the latest in ICD-10 as part of “Soaring Together: A Collaboration in Continuing Medical Education."
The Top 9 Questions Every Medical Coder Asks about Risk Adjustment and the CR...Laureen Jandroep
The Top 9 Questions Every Medical Coder Asks About Risk Adjustment and the CRC™ Certification was presented in a webinar by Certification Coaching Org (CCO), www.cco.us. A wealth of information was covered including: what Risk Adjustment (RA) entails, how this field is growing, and RA career opportunities. Also discussed was what to look for in a Risk Adjustment course. Attendees’ questions on careers in RA or preparing for the Certified Risk Adjustment Coder (CRC™) credentialing examination were answered. Presenters were Alicia Scott, CPC, CPC-I, CRC, and Chandra Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPC-I, CCS, CANPC, CEMC, CFPC, CIMC, CGSC, COSC, CRC, CCC. The host for the webinar was Boyd Staszewski.
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.
HCC Coding Services: Achieve Accurate HCC Risk Adjustment CodingJessica Parker
CMS uses HCC to compensate Medicare Advantage plans established on the health of their members. It compensates accurately for the anticipated cost expenditures of the patients by adjusting those payments based on demographic information as well as patient as their health status.
HCC Coding Services: Achieve Accurate HCC Risk Adjustment CodingJessica Parker
CMS uses HCC to compensate Medicare Advantage plans established on the health of their members. It compensates accurately for the anticipated cost expenditures of the patients by adjusting those payments based on demographic information as well as patient as their health status.
Presentation by Dr. Frank Opelka, American College of Surgeons, for mHealth Israel , April, 2022
What do PATIENTS want?
Value Based Health Care (VBHC):
Patients want to know where to go to get the care they desire. When a condition arises, patients want help managing their condition and to know where to find Safe, Affordable, Good, Equitable care for their condition. They hope to trust their care team. (SAGE). Patients struggle in a convoluted unpredictable care journey - disaggregated, transactional, duplicative, inefficient business model. Patients would like to avoid preventable harms at all cost (Safety).
What do Payers want?
Value Based Health Care (VBHC):
Payers want to optimize care to limit harm and reduce waste. Payers want to measure quality for payment incentives with limited effort. Payers seek to standardize care through practice guidelines and limit customization of care to fit each patient and in each delivery system. Realize payers’ business systems profit greatly from transactional, disaggregated models – to change would be costly.
ACS Mission: dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.
Value Based Health Care (VBHC):
A framework for redesigning healthcare with an emphasis on patient goals, around the relationships between outcomes (Quality) and affordability (Price).
V = Q / $ is an expression of the judgment a patient places on the relation of the quality of care for the price. (It is not a numeric expression). An episode of care (such as a surgical procedure or an acute/chronic medical condition) defines a care journey and applies a business model which sets a price for a bundled set of services.
Price in S-VBHC
Do patients want each transaction or a single episode which groups all the services into a meaningful package?
Tools exist which can create risk adjusted price estimates.
Policy Landscape: Extremely large federal bureaucracies with hundreds of divisions, not all of which are aligned.
Medicare: Payment
Quality – MIPS vs MVP
Innovation Center (CMMI)
Medicare Advantage (42%), ACOs (20%)
APM – Episodes of care (Bundles)/Direct Contracting
FFS/RVUs (38%)
FDA: Safety
Clinical Decision Support (Apps) as a medical device (ACS risk calculator, CoC Staging App)
CDC: Care Delivery/Pop Health
Digital Guidelines
Care Pathway Process Maps/care tracking notation
Policy Landscape
Value Based Care/Episodes of Care: V=Q/$
Numerator = Quality (defined by ACS)
Denominator = Price (defined by payment)
Production cost (defined by TDABC).
New payment models (Episodes of Care).
echnology Interoperability
Platforms/More than EHRs
Standards & Data definitions
Exchanges / Translators
FHIR/CQL/HL7
Specialty Society Role in AI & Digital Healthcare
Specialty as the content/context experts
Clinical Decision Support (CDS) (Risk Calculator, Cancer Staging)
CMS’ “MIPS THINK”
Episodes of Care
ACS Quality Model / Price
PROs
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Ana...Health Catalyst
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.
The Design of Accountable Care OrganizationsCJ Fulton
Pillars for Accountable Care
PCMH versus ACOs
Core competencies
Six core structural components of successful ACO deployment
Pioneer ACO burn and learn lessons
Barriers & root cause analysis
Patient attribution
Five modes of Accountable Care
Early value-based adopters
Value discovery assessment
Modified Triple Aim
GPRO
Breakdown by 33 Measures
A Guide for Medical Billing and Coding Audits for Wound Care Providers.pdfSolemanOne
Utilizing evidence-based clinical practice guidelines, wound care practitioners can use this medical billing road map to enhance their clinical documentation and adhere to payer coverage policy and medical necessity requirements.
NCQA’s Accreditation process provides payers with a comprehensive framework to improve quality of care and services. It allows members and employers to compare health plan performance across various plans and against industry benchmarks. NCQA accreditation has 3 parts – HEDIS, Patient experience CAHPS measures and NCQA standards
CPT E/M codes are changing January 1, 2021. This webinar unpacks those changes for you, outlining everything you need to know including:
How to navigate all the changes
What these mean for reimbursement
What you need to know to make sure your providers and coders are ready.
Telemedicine has moved to the forefront of healthcare, opening up opportunities for both practices and their patients. To help unpack some of the enormous amounts of new information, This presentation focuses on:
- Relaxing of Regulatory Issues
- How Telemedicine Can Help Your Practice
- Challenges
- The Future of Telemedicine
This episode continues our COVID-19 COVID-19 Insights Webinar discussing CMS changes, available grants and loans, existing opportunities in telehealth, and more state openings for elective surgeries.
The COVID-19 pandemic continues to present challenges to healthcare practices. This presentation covers the reinstatement of elective surgeries in a few states, the greater adoption of remote tracking, and new developments with the FCC’s Telehealth Program.
It also goes over the technology CareOptimize has developed to help streamline COVID-19 monitoring and reporting, its genesis, and how this utility can help your practice post-pandemic.
This webinar continues the COVID-19 Insights webinar series. Topics include the loans and grants being offered by the government, how they differ, and how they may benefit your practice, including SBA Loans and Grants, HHS Grants, Medicare Advance/Accelerated Payments, and Telehealth Funding. The webinar also goes over the CareOptimize technology developed to assist with streamlining COVID-19 monitoring and reporting.
Does it feel like you’re falling behind on the latest CMS regulatory updates? You’re not alone. The CareOptimize COVID-19 Insights webinar is designed to keep you informed of everything going on with CMS as healthcare practices continue to adjust. Along with CMS updates, this webinar goes over SBA loans and Fee-for-service Advance/Accelerated Medicare payments.
CareOptimize COVID-19 Webinar series episode 2 continues with the most up-to-date news from CMS along with other regulatory changes affecting the healthcare industry. The primary focus is on a trio of distinct provider models and how each of them is managing their practices while adapting to the challenges of the pandemic. We also go over the technology CareOptimize has developed aimed at streamlining COVID-19 monitoring and reporting.
MIPS continues to be a major risk, with practices who do not participate subject to a 5% penalty. This webinar covers:
Rule clarification and changes that have occured since January 1st.
Measure clarification and changes that have occured since January 1st. Your measure calculations may be changing as a result.
Where your practice should be at this point in the year.
How we can help support unique workflows and provider documentation.
In the day and age of value based medicine, it is critical to optimize your reimbursements with more accurate coding.This webinar uses specific examples to demonstrate the intricacies of accurate coding and how you can actually benefit. Questions answered include:
• How is global service reporting changing?
• What procedures require reporting?
• Who is required to report?
• When do new requirements take effect?
MACRA is quickly approaching year 2. CMS recently released their 2018 Proposed Rule, and there are some significant changes everyone should be aware of.
Rather than wading through the 1,058 pages of the Proposed Rule, join CareOptimize for a look at the most important takeaways.
In less than 30 minutes, you'll learn:
Are any of your clinicians now exempt?
What is a Virtual Group, and will it save you money?
Are your practice's priorities aligned with the newly weighted categories?
How can the Proposed Rule increase your 2018 bonus?
Accountable Care Organizations (ACOs) have been part of the healthcare landscape for a while and remain an integral part of the move toward value-based medicine. CMS recently introduced a new model in the MSSP (Medicare Shared Savings Program), ACO Track 1+.
This presentation gives a broad overview of ACOs and explains the basics of the new Track 1+ model. Topics include:
- ACOs and their role in MACRA/MIPS
- Meeting or exceeding the standards
- Why the risk might be worth it
MIPS is here. Are You Ready? CareOptimize Is.
See how the MIPS Management Solution empowers practices like yours to:
1. Know provider scores in real-time and compare those to your peers across the country
2. Provide scorecards for each MIPS category
3. Model different scenarios to determine your highest MIPS score
4. Automatically submit to CMS
5. Choose which level of assistance is best for your organization
... And More!
Let's face it, changes are coming. Healthcare is about to undergo another big shift once the new administration comes in. Between the sure things and the big questions, CareOptimize has found a bit of clarity. Join us to learn what our experts advise you to do to stay on top of it all.
Meaningful Use: Programs, Penalities, and PaymentsBen Quirk
Meaningful Use is not dead!
MIPS may be just around the corner, but MU is still very much in the picture. There is enough time, however, for your practice to optimize 2016 reporting and increase 2018 payments and avoid penalties.
This presentation takes you through the steps needed to successfully attest for 2016 and be prepared for upcoming changes.
CMS has stopped being nice about ICD10. As of October 1, 2016, the grace period for not using specific codes for certain diagnoses is gone. If you are not precise with these codes, your denial rates will go up.
This presentatio helps you learn how you can avoid high denial rates and also explains:
- Key changes and revisions
- Written guidance from CMS and OIG that may negate a new guideline
- Chapter specific changes
- How to tell when you need documentation and when you don’t
2016 MIPS Final Rule: What you need to know NOWBen Quirk
Find out why you need to pay attention to this Final Rule and what adjustments you need to make to ensure you end up on the winning side of MIPS. It's a complicated program, and results from the Final Rule don't make it any easier.
With patient responsibility becoming an increasing part of clinics AR, you need to make sure you have an effective strategy in place. Learn how to maximize your collections without negatively impacting your relationships with your patients.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
2. Risk Adjustment
What is it?
Methodology accounting for known and/or discovered health data elements
and levels comparisons of wellness among patients.
Used as a method to evaluate all patients on an equal scale.
3. Determining Factors
Risk adjustment modules utilize diagnosis codes
to determine potential patient level risks.
• Age
• Gender
• Socioeconomic Status
• Disability Status
• Insurance status
- Medicare
- Medicaid,
- Dual-eligible, etc.
• Claims data elements such
as procedure codes, place of
service codes, etc.
• Special patient-specific
conditions (enrolled in hospice or
being an ESRD patient)
ADDITIONAL ELEMENTS
4. Risk Adjustment Modules
Diagnosis based programs
HHS
Health and Human Services
Hierarchical Condition Category
CDPS
Chronic Illness and Disability
Payment Systems
HCC-C
Hierarchical Condition
Category, Part C
DRG
Diagnosis Related Groups
ACG
Adjusted Clinical Groups
5. Medicare
Hierarchal Condition Categories
• Model used by MA plans
• Takes ICD codes and filters them into Diagnosis
Groups, then into Condition Categories
• Assigns a value to each diagnosis code in the model
• Each diagnosis code carries a Risk Adjustment Factor
6. How does Risk Adjustment
Affect You?
• Physicians will treat patients on plans
funded through RA models
• Plans expect providers to document and
code diagnoses correctly
• Physician documentation and coding
establishes the complexity and
workload of patient panels
• Documentation and diagnoses become
the basis for funding and
reimbursement
?
7. How is the risk (RAF)
score developed?
Each patient has a RAF score made of:
Baseline demographic elements (age/sex and dual eligibility status)
Incremental increases based on HCC diagnoses submitted on claims from
face-to-face encounters with qualified practitioners during the calendar year
HCC coding is prospective in nature:
The work you do in this year sets the RAF and subsequent funding for next
year
All models include chronic conditions that do not change from year to year:
Diabetes, COPD, CHF, Atrial-Fib, MS, Parkinson’s, Chronic Hepatitis
8. Correct Coding
• Adherence to ICD-10 guidelines is required
under HIPAA
• Documentation must show condition was
monitored, evaluated, assessed, or treated
(MEAT)
• A diagnosis code may only be reported if it
is explicitly spelled out in the medical
record
• No coding from problem lists, super bills,
or medical history
Treatment is prima facia evidence of a diagnosis—
if you are treating, it exists
9. MEAT the Chronic Condition
Monitor
Signs
Symptoms
Disease progression
Disease regression
Evaluate
Test results
Medication effectiveness
Response to treatment
Assess
Ordering tests
Discussion
Review records
Counseling
Treat
Medications
Therapies
Other modalities
M E A T
11. Risk Adjustment Data Validation
• CMS identifies a random stratified sample of patients to audit.
• Only Part C HCCs are audited in a RADV.
• Health plans must submit up to five best records demonstrating
diagnoses that support the HCC values paid as current in the year being
audited.
• Supplemental diagnoses (those not originally submitted via claims) may
be approved if they are documented as current diagnoses in the record.
• E submission of all diagnoses (with HCCs) are cumulative, so there may
be a negative or positive financial outcome overall in such an audit.
12. Health and Human Services
HCC Model
• Section 1343 of the Affordable Care Act (ACA) calls for a risk adjustment model.
Health and Human Services (HHS) created a risk adjustment model based on the
HCC classification system; however this model was developed using commercial
claims.
• The hierarchical grouping logic is similar to the Medicare methodology, but HHS
selected a different set of HCCs for the federal risk adjustment methodology to
reflect the population differences.
• Patients are grouped in this model by age (adult,child,infant) and by metal
(platinum, gold, silver, and bronze).
• This plan does not currently review prescription-based diagnoses such as those
found in the HCC-D used by Medicare.
13. ACA Plan
ACA Plan Category The insurance
company pays
The patient pays
Platinum 90% 10%
Gold 80% 20%
Silver 70% 30%
Bronze 60% 40%
Catastrophic Less than 60% More than 40%
14. Medicaid Chronic Illness and Disability
Payment System (CDPS)
• In the Medicaid Chronic Illness and Disability Payment System (CDPS)
risk adjustment model, there are far more diagnosis codes identified
than are included in the Medicare HCC model
• While these CDPS diagnoses also carry a numeric value for risk, they are
also rated as “high,” “medium,” and “low” risk overall.
• This rating is used in hierarchal value setting. Where low is trumped by
medium and medium is trumped by high.
• Uses data from both claims and Medicaid prescriptions (MRx)
15. Cardiovascular Category
CARVH
3 Stage 1
groups
7 diagnoses
CARM
13 Stage 1
groups
53 diagnoses
CARL
26 Stage 1
groups
314 diagnoses
CAREL
2 Stage 1
groups
35 diagnoses
Four Levels
The suffix of the Cardiovascular Category (CAR)
establishes its place in the hierarchy:
• VH (Very High) (weight 2.037): heart transplants, valves, etc.
• M (Medium) (weight 0.805): heart attacks, etc.
• L (Low) (weight 0.368): heart disease, etc.
• EL (Extra Low): hypertension, etc.
18. MIPS and Risk Adjustment
HCC coding is the system that will be used for Risk Adjustment under
MIPS.
At its core, diagnosis codes (ICD-10) are assigned a weight that measures patient
acuity. Medicare expects that patients with higher HCC scores will consume more
healthcare dollars and have worse outcomes.
If 60% of the MIPS score for providers is going to come from risk adjusted quality and
resource use scores, it is critically important to accurately reflect the acuity of their
patient population. Doing so will allow their quality and cost scores to accurately
reflect the excellent care provided by physicians.
Your diagnosis coding is about to become much more important, both for
immediate fee-for-service reimbursement and over the following two years
as Medicare uses that diagnosis data for Risk Adjustment under MIPS.
19. Care Holdings Group
Comprehensive Value Based
Healthcare Services
Full risk
Independent
Physician
Association
--
More than
100
providers to
date
Network of
five full risk,
fully owned
Medicare
Advantage
centers
--
Focused on
care
coordination
&
preventative
medicine
Shared Risk,
Commercial
ACOs
--
Shared Risk
Medicare
ACOs
--
Full spectrum
healthcare
ecosystem
Consulting
professionals
expert in
healthcare
regulatory and
technology
strategies
--
Shared Upside
partnerships
All-inclusive
optical
services
ALSO
AVAILABLE
Dental
Services
--
Pharmacy
Services
20. Benefits of
The CareHoldings Group Network
Full-Risk, Proven Model
We know the benefits of this model because we use it every day in our five
Medicare Advantage centers and with our providers in our MSO.
Healthcare Experts
Our consultants keep up to date with the latest in healthcare technology and
regulatory issues, maximizing revenue and optimizing services for every practice.
All-Inclusive Healthcare Services
From basic needs to specialized care, we are able to provide the very best in
healthcare services.
Value Based Focus
Our experience and capabilities result in increasing value while reducing costs
and raising quality scores.
21. Baseline Premium $710.00
PREMIUM $710.00
Baseline Premium $710.00
PRIMARY PULMONARY
HYPERTENSION * .398
CHRONIC KIDNEY
DISEASE STAGE II MILD
*.357
DIABETES WITH RENAL
MANIFESTATIONS
*.585
PREMIUM $1661.40
*examples based on 79 year old male
Accurate HHC Coding:
Proven Revenue Producer
22. CareOptimize Coding Module
• Integrates into the physician workflow at
the point of care (Inside EHR)
• Automates coding gaps detection for more
accurate coding and risk scoring
(Identify missed HCC codes)
• Conducts prospective and retrospective
coding (Improve RAF scores)
• Analyzes projected coding patterns and
provider documentation gaps
• Improves care planning and patient
outcomes