Results for Risk Adjustment

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The creation and development of robotic process automation (RPA) has had a tremendous impact on various industries over the last few years. While companies in all sectors have benefited from this technology, RPA has been particularly useful for healthcare revenue cycle management (RCM).Healthcare organizations like hospitals, physicians’ groups, and other ...Read More
One Platform for All Compliance & Auditing Requirements I. Coding Audits: The Cornerstone of Compliance & Revenue IntegrityAccording to the Healthcare Financial Management Association (HFMA), lowering compliance risk and ensuring the accuracy of charges should be top concerns of revenue integrity programs.4 Administrative costs, which are frequently cited as a ...Read More
"HFMA calls credit balances the “stealth aircraft of hospital patient accounting.” I. Credit Balances Are Not Always What They SeemCredit is a word we hear almost daily, and many people are already familiar with the fact that accounting uses credits and debits to ‘balance the books.’ In the everyday vernacular, ...Read More
Client Background and Context Client with 20+ risk-bearing locations & various data input sources wanted to: Partner with a platform to audit codes received from multiple sourcesImprove productivity of each of their locations & divisionsIncrease data quality of codes added by internal & external partnersEnhance operating margins through cost optimization Solution ...Read More
The Centers for Medicare and Medicaid Services (CMS) recently announced plans to ramp up its risk adjustment data validation (RADV) audit program in 2020 based on a recent study by the Office of Inspector General (OIG), which found potential issues related to Medicare Advantage Organizations (MAOs) using chart reviews to ...Read More
With profit margins shrinking and the cost of health care going nowhere but up, operational leaders and consultants throughout the healthcare industry are looking in every nook and cranny to either find ways to cut costs or generate more revenue. With the ongoing need for costly equipment, an expert workforce ...Read More
Population health and the transition to two-sided risk is no easy feat – it’s a monumental shift in the way providers, payers and hospitals think about the delivery of health care. And, while, we all know it’s coming – knowing how to get there and doing it successfully is the ...Read More