In the ever-evolving landscape of healthcare compliance, the Risk Adjustment Data Validation (RADV) audit stands out as a critical process that demands meticulous preparation. Being proactive and implementing a strategic approach can not only streamline the audit process but also ensure your organization’s success. Let’s delve into important points that organizations should remember to execute … The post Preparing for a RADV Audit? – Follow these Key steps appeared first on DoctusTech ..read more

HCC (Hierarchical condition category) coding is a complex and ever-changing field, and training clinicians in the traditional seminar format can cause significant pain points for healthcare providers and administrators. Here are just a few examples of the pain points that result from HCC coding education seminars:   Inaccurate or incomplete information: Traditional seminars often result … The post Overcoming the costs of bad HCC coding education appeared first on DoctusTech ..read more

The basics of RAF and how it is calculated. Total HCCs for a single patient equal RAF score   Every VBC patient has a Risk Adjustment Factor (RAF) score, and the score follows the patient. The more medically complex diagnoses render a higher RAF score. The higher the score, the more resources required to care … The post Risk, Revenue & Care: How HCC coding and RAF impact Value-Based Care Revenue and Patient Outcomes appeared first on DoctusTech ..read more

Diagnosing for risk in VBC   Diagnosing for medical complexity Physician diagnoses patients with all medical conditions.   One shift when transitioning to Value-Based Care is the need to diagnose very specifically for complexity, rather than simply diagnosing a disease. In the old Fee-For-Service (FFS) model, it would be reasonable to diagnose simply diabetes mellitus. … The post Risk, Revenue & Care: How HCC coding and RAF impact Value-Based Care Revenue and Patient Outcomes appeared first on DoctusTech ..read more

Here is the cheat sheet you’re looking for: DOWNLOAD *Be sure link opens in a new tab.   ICD-10 codes are hard. Knowing which codes to use for Risk Adjustment in your Value-Based Care is even harder. And even the best available clinician training rarely yields lasting behavior change. Your team needs a resource in … The post New HCC Coding Cheat Sheet for 2022 appeared first on DoctusTech ..read more

Fred Schulte, Kaiser Health News and Holly Hacker Republished with permission November 21, 2022 Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some plans overbilling the government more than $1,000 per patient a year on average.   Audits — Hidden Until Now — … The post Bolus of Vintage CMS Audits Reveal Millions in MA Overcharges – KHN appeared first on DoctusTech ..read more

Values-based healthcare reimbursement has been adopted more quickly in some healthcare sectors than in others.   According to the LAN’s latest APM Measurement report, 40.9% of US healthcare payments—representing over 238 million Americans and more than 80% of the covered population—were generated through value-based reimbursement programs last year. Population-based payments and downside risk agreements were … The post VBC Industry Insights From HCP-LAN’s Annual Report appeared first on DoctusTech ..read more

We get it, HCC coding is hard: choosing the right HCC is nuanced, and can seem subjective. But when you see a patient, you are probably not reaching for a cheat sheet on how to diagnose this patient, right? How is it that HCC coding sent you searching for a cheat sheet?   And learning … The post So Your Team Downloaded Our Cheat Sheet… appeared first on DoctusTech ..read more

With the flu season ramping at unprecedented rates, and a new surge of RSV coming when COVID-19 numbers are rising again, the topic of a healthcare surge emergency is back in the headlines. What the New York Times is calling a “Tripledemic” is threatening to overwhelm providers and hospitals yet again. During the peak of … The post How Hospitals Can Tackle Surges With Value-Based Care appeared first on DoctusTech ..read more

Audits are no longer just for large payors, provider groups are feeling the pressure of rising compliance audits, and the playing field is complicated to negotiate. Some of this may seem unfair, but with the cost of medical fraud on the rise, the DOJ, CMS, OIG, HMS and all the other initials are not going … The post HCC Codes Most Targeted by DOJ and Strategies to Remain Compliant appeared first on DoctusTech ..read more