We’ve all heard the adage – when it comes to healthcare, if it wasn’t documented, it wasn’t done. This couldn’t be more true when it comes to value-based care – particularly as it relates to the Centers for Medicare & Medicaid Services risk adjustment program. This innovative program offers higher payments to providers who deliver …
AI – Enhancing the Future of Medical Billing & Coding
Posted in Health Information Management (HIM), Healthcare TechnologyThe State of US Hospitals Shrinking profit margins, reducing reimbursement rates and the uncertainties of healthcare reform have made operating a hospital a very risky business. Consolidation of small, rural hospitals into larger system has helped save many struggling hospitals, but others continue to lose money despite their best efforts to cut costs. In fact, …
Rev Up Your Revenue Cycle with AI
Posted in Health Information Management (HIM), Healthcare TechnologyWith 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 and the state-of-the-art facilities needed …
It’s Working – CMS Report Concludes the Effectiveness of Risk Adjustment
Posted in Healthcare Technology, Payer SolutionsIn 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 …
Accurate RAF Scores Could Mean Billions in Savings for Medicare
Posted in Payer SolutionsA 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 …