Sue Malcolm, BS, CPC

Stay out of harm’s way when it comes to risk adjustment compliance. The number one error for risk adjustment documentation and coding, based on dozens of OIG audits released over the past two years, is coding for neoplasms. It is an easy problem to understand. Learn more: https://conta.cc/3UXdY7u

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📢 Attention Risk Adjustment professionals! The April 26th V28 workshop is SOLD OUT. But don't worry, tickets are still available for May, June and July. During the workshops, we'll cover important topics such as managing HCCs, calculating risk scores for 2024 and 2025, and reviewing updated HCCs for V28. We'll also sharpen our auditing skills and take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. Don't miss out on this opportunity to enhance your skills and gain valuable insights. Advanced Risk Management and HCC Coding for VBP Workshop Fri, 31 May 2024 9:30 AM EDT https://lnkd.in/gsBZRrPP   Advanced Risk Management and HCC Coding for VBP Workshop Fri, 28 Jun 2024 9:30 AM EDT https://lnkd.in/g7g-XRhi   Advanced Risk Management and HCC Coding for VBP Workshop Fri, 26 Jul 2024 9:30 AM EDT https://lnkd.in/gxN2WRUU #riskadjustment #medicareadvantage #ACO #valuebasedpayments

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Understanding Prior Authorization in Healthcare 🔍 Insurance companies use prior authorization to approve or deny coverage for a prescribed medication. 💡Prior Authorization ensures the medication is cost-effective and used appropriately, based on clinical guidelines, formulary status, and patient-specific factors. 🤝 Collaboration is key. Effective communication between healthcare providers, pharmacists, and insurers is crucial for a smooth prior authorization process. #Healthcare #Pharmacy #PriorAuthorization 

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Earlier this year, Centers for Medicare & Medicaid Services rolled out changes to 340B modifier requirements for Part B drugs. 340B Program expert, Dennis Killian, tells you what you need to know: https://lnkd.in/ed_xvYNf #pharmacy #340B #Medicare #PartB #healthcare

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Navigating ICD-10-CM codes can be challenging, especially with the frequent misapplication of guideline I.A.15 regarding “with” and “in.” Our latest article explores common errors and provides strategies to leverage the Alphabetic Index for precise coding. Ensure your coding practices are compliant and read our article here: https://ow.ly/fuOE50SlgkM #YESHIMConsulting #ICD10 #ICD10PCS #ICD10CM #MedicalCoding #HealthcareCompliance #CodingAccuracy #HealthcareIndustry

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OIG testimony highlights critical issues surrounding risk adjustment in Medicare Advantage. #oig #medicareadvantage #riskadjustment #medicalcoding #medicalbilling #qualcodeinc Link: https://lnkd.in/eF_KVySZ

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Impact of Policy Changes on SNF Billing Let's know about how recent policy changes affect Skilled Nursing Facility (SNF) billing: 🔹Understand new reimbursement rules. 🔹Adapt to updated documentation requirements. 🔹Navigate changes in Medicare/Medicaid guidelines. 🔹Prepare for potential shifts in billing procedures. Ready to navigate these changes effectively? Let's discuss how they impact SNF billing practices today! Know more: https://bit.ly/452uyGo For more insights, Contact 24/7 Medical Billing Services for a free consultation at  888-502-0537 / info@247medicalbillingservices.com. #SNFBilling #HealthcarePolicy #MedicalBilling #MedicareBilling #HealthcareRegulations #SNFReimbursement #HealthcareFinance #BillingCompliance #MedicalBilling #LongTermCare #SkilledNursingFacilities #BillingUpdates #ReimbursementRates #SkilledNursingFacilityBilling #247MedicalBillingServices

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Adjusting to risk: Seizing opportunities in risk adjustment coding Wednesday, May 1, 1-2 p.m. EST Speakers: Crystal May, Risk Adjustment Consultant, Norwood; Brian Murphy, Branding Director, Norwood and host of Off the Record; Register here: https://lnkd.in/gPDewtDY It’s often been said that the only constant in life is change. And the mid-revenue cycle is no exception. As new regulations emerge and new technologies develop, professions get radically transformed—or even erased altogether. The antidote is a commitment to lifelong learning, and embracing the discomfort that accompanies growth. Join Crystal May, CCS, CPC, CDEO, CPMA, CRC, Approved Instructor, Risk Adjustment Consultant for Norwood, and Brian Murphy, host of the Off the Record podcast, for this free one-hour live webinar. Crystal and Brian will discuss Crystal’s healthcare journey that eventually led to risk adjustment. They’ll also review some of the common findings and coding errors she’s seeing while conducting in chart reviews. This is not a technical .ppt-driven presentation, but a conversation about Crystal’s journey that may provide fuel for your own career in risk adjustment. Note: No CEUs will be provided for this program. Register here: https://lnkd.in/gPDewtDY

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Adjusting to risk: Seizing opportunities in risk adjustment coding Wednesday, May 1, 1-2 p.m. EST Speakers: Crystal May, Risk Adjustment Consultant, Norwood; Brian Murphy, Branding Director, Norwood and host of Off the Record; Register here: https://lnkd.in/gPDewtDY It’s often been said that the only constant in life is change. And the mid-revenue cycle is no exception. As new regulations emerge and new technologies develop, professions get radically transformed—or even erased altogether. The antidote is a commitment to lifelong learning, and embracing the discomfort that accompanies growth. Join Crystal May, CCS, CPC, CDEO, CPMA, CRC, Approved Instructor, Risk Adjustment Consultant for Norwood, and Brian Murphy, host of the Off the Record podcast, for this free one-hour live webinar. Crystal and Brian will discuss Crystal’s healthcare journey that eventually led to risk adjustment. They’ll also review some of the common findings and coding errors she’s seeing while conducting in chart reviews. This is not a technical .ppt-driven presentation, but a conversation about Crystal’s journey that may provide fuel for your own career in risk adjustment. Note: No CEUs will be provided for this program. Register here: https://lnkd.in/gPDewtDY

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Navigating the complexities of HCC coding can be daunting for many health systems. Learn how UConn Health overcame this challenge through a strategic partnership with PINC AI™ Stanson, leading to significant improvements. Check out their journey: https://lnkd.in/e_XjRteD

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#RISE Best experts at the 2024 Risk Adjustment Conference always helping to innovative strategies and best practices for optimizing healthcare outcomes, risk adjustment success and regulatory compliance. RISE

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FRAUD. Every health plan, TPA, and state Medicaid Director knows there is actual fraud happening in their system. The problem is that they can't see it or can't see it fast enough to prevent payment to stop bad actors before damage is done. The primary reason is that every legacy healthcare claims editing system is claims data-centric. To see dynamic fraud and collusion schemes, and to see them fast enough, claims editing and claims analytics must be provider-centric NOT claims data-centric. Learn how to Find, Fight, and Prevent Fraud Fast™ with the patented power of Integr8 AI Risk Detection technology™ at HPRI East, May 22-23 in Boston. Healthcare Payment & Revenue Integrity Series (HPRI) #HPRIEast #Paymentintegrity #paymentintegrityvendors #fraud #healthcarefraud #healthcare #AI

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💡 #DidYouKnow that the HOSP Alliance is skilled in addressing crucial challenges facing your business, like increasing access to patients and optimizing your #340B program? 📣 Learn more by downloading the HOSP Alliance Best Practices Overview Paper: https://brnw.ch/21wK7pe #SpecialtyPharmacy #PatientCare #Pharmaceutical

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👩‍⚕️ **Prior Authorization Process for Dermatologists** 🩺 Are you a dermatologist feeling overwhelmed by the prior authorization process for your specialized treatments? Understanding the ins and outs of prior authorization can streamline your practice and improve patient care. Here are some key points to consider: 1. **Documentation is Key**: Ensure all necessary patient information, medical records, and treatment justifications are included in your prior authorization request. Clear and detailed documentation can expedite the approval process. 2. **Know Your Insurance Plans**: Familiarize yourself with the specific prior authorization requirements of each insurance plan you work with. Different payers may have varying criteria and processes, so staying informed is crucial. 3. **Stay Organized**: Create a systematic approach to managing prior authorizations, keeping track of submission dates, follow-ups, and approvals. Utilizing technology or outsourcing services can help streamline this process. 4. **Utilize Clinical Guidelines**: Refer to evidence-based clinical guidelines when submitting prior authorization requests. Aligning your treatment plans with established protocols can strengthen your case for approval. 5. **Communicate Effectively**: Maintain open communication with insurance companies, conveying the medical necessity and urgency of the treatments you recommend. Effective dialogue can facilitate smoother prior authorization approvals. By following these tips, dermatologists can navigate the prior authorization process more efficiently, ensuring timely access to specialized care for their patients. Have you faced any challenges with prior authorizations in dermatology? Share your experiences below! 🌟 If you need Prior Authorization Outsourcing Services, visit our website at 🌐 https://www.staffingly.com 📧 support@staffingly.com 📞 Call Toll Free: (800) 489-5877 📱 SMS/Text : +1(347) 545-7070 #Dermatology #HealthcareProviders #PriorAuthorization #SpecializedCare #InsuranceCoverage

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Find the Condition and Its ICD-10-CM Code! Can you solve this medical puzzle? Identify the 8-letter genetic condition that results in the inherited absence or reduction of melanin production by melanocytes. Your hint: _ _ B _ N _ _ _. Test your knowledge and see if you can crack the code! #MedicalPuzzle #ICD10 #MedicalCoding #Metacodify #GeneticConditions #MedicalKnowledge #HealthcareProfessionals #LearnWithUs #SolveThePuzzle #MedicalEducation #Healthcare #MedicalTraining #MedStudentLife #Genetics #Melanin #HealthcareQuiz #MedicalChallenges #KnowledgeIsPower #MedicalCommunity

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Earlier this year, Centers for Medicare & Medicaid Services provided guidance encouraging #PACE organizations to start submitting risk adjustment data using the Encounter Data System.   Will the transition impact program risk scores or reimbursement? Read our blog post to find out and get answers to other key questions.   👉Learn more: https://lnkd.in/eQ4dTmCQ #RiskAdjustment #ValueBasedCare

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This week, the Centers for Medicare & Medicaid Services hosted a webinar to provide more information about the expansion of #Section111 NGHP TPOC reporting to include WCMSA information. Read our latest blog for webinar highlights at https://lnkd.in/g7AGBchv. #MSPcompliance #MedicareSetAside

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