Risk Adjustment Meets Artificial Intelligence – A Perfect Match
/ Posted in Gebbs HealthcareBig data is all the rage – transforming industries from tech to retail and much more. Healthcare – an industry slow to adopt technology in many ways now has access to more data than ever before with the widespread adoption of electronic health records (EHRs). But, what do we do with all this data in …
It’s Working – CMS Report Concludes the Effectiveness of Risk Adjustment
/ Posted in Gebbs HealthcareIn late June, the Centers for Medicare & Medicaid Services released data demonstrating that its Risk Adjustment Program – developed as part of the Affordable Care Act just five years ago – is working just as planned. What was the plan? To prevent payers from developing plans intended to attract healthier patients and to incentivize …
The #1 Most Critical Driver in the Successful Adoption of Shared Risk Programs
/ Posted in Gebbs HealthcareThe unavoidable shift toward value-based and two-sided risk payment models is here to stay – and while the benefits are countless, the journey thus far has been slow and somewhat painful for payers, providers and healthcare organizations alike. Healthcare is one of the slowest industries to effectively adopt technology and the reasons for this are …
Strategies for Mastering Two-Sided Risk
/ Posted in Gebbs HealthcarePopulation 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 real challenge. While most accountable …
Accurate RAF Scores Could Mean Billions in Savings for Medicare
/ Posted in GeBBS Healthcare Solutions, Medicaid, MedicareA recent study published by the Kaiser Family Foundation sheds light on a complex issue – how to determine the real or predicted cost of care for Medicare Advantage plan members when establishing RAF scores is based on the inexact science of provider documentation. The study released this spring indicated that those who were enrolled …
Five-Year Growth Explosion Anticipated for Medical Billing Outsourcing
/ Posted in Coding Outsourcing, GeBBS Healthcare Solutions, Medical Coding, Medical Coding Outsourcing, Offshore Medical Billing, Outsource Coding, Value-Based CareThe administrative costs associated with medical billing within a physician practice are becoming unmanageable for independent and major health-system affiliated practices alike. A 2018 research study was conducted by experts at Duke University and Harvard designed to examine the administrative costs specific to large academic medical centers using electronic health record (EHR) technology – and …
Keeping an Eye on Value-Based Care – 3 Things to Watch
/ Posted in Technology, Value-Based Care“Work smarter, not harder.” This age-old philosophy is the mantra behind value-based health care. After all, more health care doesn’t necessarily mean better outcomes – this much has been proven by evidence-based medicine time and again. As the fee-for-service model of health care slowly fades away, true value-based care (and all the benefits that come …
With Telehealth on the Rise, Policy & Payers Are Catching Up
/ Posted in Accountable Care Organizations (ACOs), Medicare, TelehealthTelehealth is a key element of our country’s health care transformation – and health care providers, payers and patients are getting on board today more quickly than ever. After all, getting timely and convenient medical diagnosis and treatment using your computer, phone or tablet – anywhere, anytime, is of incredible value in our busy, technology-driven …
Shedding Light on Alternate Payment Models
/ Posted in Accountable Care Organizations (ACOs), CMS, Coding Accuracy, Medicaid, MedicareThe shift to value in healthcare is no easy feat. While the Centers for Medicare and Medicaid Services (CMS), accountable care organizations (ACOs) and healthcare systems are all working towards it, true success requires a commitment to collaboration, communication and transparency.
Why the Government is Outsourcing (and You Should, Too)
/ Posted in Accounts Receivable (A/R), Health Information Management (HIM), Revenue Cycle Management (RCM)The data is clear – policymakers are making every effort to reduce healthcare costs, particularly as states struggle with significant budget deficits across the country. To do this, many state governments have elected to outsource the management of Medicaid and Medicare programs to managed care companies. According to Modern Healthcare, 34% of Medicare beneficiaries are …