Shedding Light on Alternate Payment Models

Posted in Accountable Care Organizations (ACOs), CMS, Coding Accuracy, Medicaid, Medicare

The 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.

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Encounter Data…Why Getting It Right is More Important Than Ever

Posted in Coding Accuracy, Medical Coding, Remote Medical Coding

Earlier this month, CMS announced changes to future payments for Medicare Advantage plans that will take effect in 2020. While a pay raise is part of the plan, what’s causing a stir is that payment will now be based on a higher percentage of patient encounter data (up to 25% from 10%). Many (especially payers) have argued that encounter data is often incomplete and inaccurate when compared to diagnoses, since encounter data relies on provider documentation.

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Coding Audits Aimed at Clinical Documentation Improvement

Posted in Clinical Documentation Improvement (CDI), Coding Accuracy

With the 10th Annual Association of Clinical Documentation Improvement Specialists (ACDIS) Conference coming up this week in Las Vegas, Nevada, it is appropriate to remind healthcare professionals about the importance of medical coding audits and Clinical Documentation Improvement (CDI). Coding audits aimed at clinical documentation improvement can enhance your facility’s performance in multiple ways and …

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Medical Coding Outsourcing is More Than Staffing

Posted in Business Process Outsourcing (BPO), Coding Accuracy, Medical Coding BPO, Medical Coding Outsourcing, Offshore Medical Billing, Offshore Medical Coding, Offshore Revenue Cycle Management, Outsource Coding, Outsourced Medical Billing, Outsourced Medical Coding, Remote Medical Coding

Outsourced medical coding’s traditional approach has been staff augmentation. It has been typically used to meet short-term gap needs due to turnover, extended absences, or electronic medical record (EMR) changes. In other words, it has been used when a healthcare provider needed temporary additional resources to supplement its existing resources. However, from our experience, this …

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