“Documentation that does not support the diagnosis and procedure codes submitted can lead to a reduction, denial, or take back of payments as well as inaccurate quality scores. No matter what the setting is, the goal of clinical documentation improvement (CDI) is to assist in ensuring quality documentation. The documentation must be reliable, precise, complete, consistent, clear, legible, and timely.”
“Can CDI have an impact on quality initiatives? Certainly! The core of many quality initiatives is the health record and the documentation contained within. This article will present a high-level view of some of those quality initiatives and how CDI can help with the attainment of accurate, quality documentation to support the quality initiatives.”
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“The medical decision-making (MDM) component of evaluation and management (E/M) services is perhaps the most crucial element in determining the correct level of service assignment for patient encounters. The majority of individuals involved in the E/M coding process may not agree on the interpretation of the components, but would agree that the clinical thought process expressed in the MDM components best describes the level of medical necessity, as well as the level of service necessary for that specific problem.” please click the following link to continue reading the article: https://www.aapc.com/blog/39748-mdm-the-driving-force-in-em-assignments/
“Amid yet another delay in CMS-led bundled payment programs, the popular value-based reimbursement model seems poised to continue as a favorite for providers. Bundled payments serve as an entry to value-based care because of the relatively low risk providers take on. And while these programs aren’t yet proven to be successful, there is enough positive data to excite those who champion paying for healthcare based on value.” Please click the following link to continue reading http://www.healthcaredive.com/news/despite-federal-delays-bundled-payments-will-be-entrenched-in-us-healthcar/446284/
“Nearly three-quarters (73 percent) of providers prefer a fee-for-service model over value-based reimbursement structures even though almost one-half acknowledged that the traditional payment model contributed to higher healthcare costs, a recent Bain & Company survey showed.” please click on the following link to continue reading the article
“Failing to thoroughly document signs and symptoms, assessments, and treatments of chronic diseases creates a ripple effect of misfortune. First, all relevant codes are not captured; this leads to improper payment (not to mention, an injustice to the patient). The next thing you know, the claim fails a Risk Adjustment Data Validation (RADV) or Office of Inspector General (OIG) audit based on insufficient documentation. The final blow is a funding take-back. Physicians know this, but many of them do not know how to document sufficiently to support the eight to 10 (or more) diagnoses they might list in the assessment. This is where the healthcare business professional’s expertise comes into play.”
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“Medical coding is a major factor in obtaining insurance reimbursement as well as maintaining patient records. Coding claims accurately lets the insurance payer know the illness or injury of the patient and the method of treatment.”………. Click the link to continue reading this article https://www.verywell.com/basic-rules-for-medical-coding-2317087
GREENWOOD, Ind., Jan. 10, 2017 /PRNewswire/ — Medical code verification services provider AmeriVeri (http://www.ameriveri.com) adamantly supports the move to value-based payment (VBP) programs for government and commercial payers. Already well underway throughout the industry, this sea change in how payments are calculated will lead to superior patient care and more precise data for EHRs, providers, healthcare policymakers and researchers. And with the help of AmeriVeri’s proprietary verification process, third party administrators (TPAs) and insurance companies can ensure that VBP programs deliver on their promise to reduce skyrocketing healthcare costs.
“The twin pillars of a well-conceived and effective VBP program are precise documentation and coding proficiency,” says AmeriVeri Director of Claims Management Steffeny Brewer. “Our purpose is to maximize that precision, saving money for payers and enabling providers and provider networks focus on achieving quality benchmarks.”
Value-based payment (VBP) programs utilize documented and coded patient outcomes to decide whether a patient was provided quality care. The top three reasons for inaccurate claims payment can be attributed to insufficient documentation, medically unnecessary services, and incorrect diagnosis coding. The proprietary service developed by AmeriVeri detects medical coding errors routinely missed by every other adjudication process.
On average, AmeriVeri identifies two to six errors per every 100 lines on medical claims. In their experience, Healthcare facilities and providers want and need to achieve accurate claim reporting, as clean claim reporting directly impacts their payment for services rendered. In between those twin goals exists the opportunities to (1) create massive healthcare savings, and (2) help assure the accuracy of medical records. The easiest, most efficient, least expensive method to achieve those goals is to utilize AmeriVeri’s proprietary process. Set up takes minutes, and turn-around time is one hour or less.
Value-based payment is a fundamentally different way of reimbursing medical claims; it rewards providers for achieving superior outcomes, and in many cases, penalizes them for complications and re-admittances. On the other hand, the fee-for-services model, which has long been the standard, looks only at volume. In other words, fee-for-services pays for inputs, while VBP pays for outputs. While this payment model can take many forms, they share the essential goals of improving care and trimming costs.
An estimated 30% of all healthcare dollars are wasted. A major emphasis of VBP is to reduce that number and slow the rapid inflation of healthcare costs. AmeriVeri shares that mission; its proprietary medical code verification process already has the capacity to save the country $6.5 billion annually in healthcare costs.
The Deficit Reduction Act of 2005 introduced the first VBP program, and the Center for Medicare and Medicaid Services rolled out a version (Hospital VBP) in 2009. Since then, the Affordable Care Act has made that program permanent. Commercial insurance companies have been quick to follow the lead of government payers. Both Anthem and UnitedHealthcare have steadily increased their commitment to numerous VBP programs. Reimbursement programs tied to value rather than volume will shortly become the standard model. The Department of Health and Human Services has set an ambitious goal for 90% of Medicare claims to be value-based by 2018. Meanwhile, the CMS reports that it’s ahead of schedule on its own goals for transition.
Making the move toward VBP programs possible has been the rollout of ICD-10 diagnostic codes. This new set of codes allows for more specificity in diagnosis, condition severity and outcomes – data points that are essential in determining reimbursement level. Industry analysts have rightly observed that providers should be embracing ICD-10 sooner rather than later.
AmeriVeri functions as a unique additional filter to assure payers that codes are effort-free. What distinguishes the service from other adjudication software is its focus on “medical necessity” — AmeriVeri’s code verification can detect when procedure and diagnosis codes do not make a logical pairing, and kick the claim back to the provider for editing and resubmittal. The service routinely identifies two to six errors for every 100 claim lines. Just as importantly, AmeriVeri safeguards the accuracy of patients’ medical records, which contributes to long-term quality of care.
The simultaneous shift toward VBP and ICD-10 is no small challenge for many providers, especially those responsible for their own coding. Billing companies, too, must make big adjustments to accommodate this new paradigm. AmeriVeri is well positioned to help this transition as smooth as possible.
About AmeriVeri CR, LLC
AmeriVeri offices are located in Greenwood, IN, and Denver, CO, with affiliates in Chicago, Minneapolis, St. Louis, Columbus, Cincinnati, Atlanta, and Dallas, providing nationwide enhanced medical code verification services in the Major Medical, Workers’ Comp and Medicaid arenas. Implementing AmeriVeri’s code verification service is fast and seamless with no new software to install, and a one hour turnaround time. AmeriVeri maintains a 100% client retention record.