The Provider's Role in Risk Coding

Posted by Continuum on Jun 19, 2018 11:32:00 AM

Physicians must code diagnoses properly to succeed under Medicare Advantage & other value-based contracts 

Each year, CMS sets cost benchmarks for every Medicare Advantage member, based on the patients’ diagnoses during the prior year. But what if the physician hasn’t reported their patients’ health information accurately or fully? The result is often benchmarks that are set too low, and costs of care exceeding benchmarks.

The payer then thinks the doctor spent too much on members’ care, and does not recognize or reward the value (high quality/lower cost) of the care provided by the physician. 

That's why proper Medicare Risk coding—entering diagnosis codes in the EMR and on claims—is essential. Providers who follow best practices for risk coding have a better chance of earning shared savings. 

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Topics: coding, icd-10, value-based care, Medicare Advantage, risk adjustment, risk coding, risk scoring

Tips to Maximize ICD-10 Coding Reimbursements

Posted by Continuum on Apr 27, 2016 4:28:14 PM

ICD-10: three letters and two numbers that caused much anxiety and stress for the medical community.                           Continuum’s coding team effectively prepared its clients for a smooth transition with little incident. It took approximately two years of hard work to prepare for the update to ICD-10, which went into effect in October 2015.

While it's been only six months, experts say much of the trepidation and hype were oveblown. The fear of denials, lost revenue, and work flow is nowhere to be seen.

A Physicians Practice survey revealed that 47.3 percent of readers say they are having no problems with the ICD-10 transition and have not seen an increase in claims rejections. Another survey found that 60 percent of practices said they have not seen an impact on monthly revenue1.

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Topics: coding, icd-10, payer reimbursement

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