Kameron Gifford, CPC’s Post

This week, let's tackle a common misstep in Risk Adjustment program implementation: postponing the introduction of a Clinical Documentation Integrity (CDI) program until phase II. Chart reviews play a crucial role in ensuring the accuracy and completeness of documentation. This correct documentation and coding, in turn, are essential for securing proper reimbursement. Moreover, both documentation and coding shed light on service utilization and act as predictive factors for the costs associated with patient care. To maximize success, remember to: 🔍 Engage a CDI expert early in your program. 📊 Conduct regular chart reviews to spot inaccuracies in documentation. 📚 Utilize insights from these reviews for provider education.  🏥 Implement a pre-visit program to identify suspects, facilitating provider-patient diagnosis discussions. Don't let CDI become an afterthought – make it a foundational component of your Risk Adjustment strategy. #Healthcare #RiskAdjustment #valuebasedcare

Great assessment and advice on how to successfully structure and implement a risk adjustment program. Clinical documentation is the CORE of capturing accurate disease burden and CDI specialists should be an inherent component of the first steps any organization takes to improve their capture and understanding of their patients level of illness.

Mastering Medical Coding and Risk Adjustment: Tips for the AAPC CRC Exam Medical coding in the realm of risk adjustment plays a crucial role in healthcare finance and patient care management. As you prepare for the AAPC Certified Risk Adjustment Coder (CRC) exam, here are essential tips to help you excel: https://lnkd.in/dmXXKZxs

EARN 7 AAPC CEUs and/or 6 AAFP CMEs for $49!! Vast changes are coming to Medicare Risk Adjustment. Is your team ready? Workshop Agenda: ­Discuss the importance of managing HCCs year over year. What resources are available from CMS to help? When is the Advanced Notice published? What are the components of a risk score? How will CMS calculate risk scores for 2025? Review NEW and updated HCCs. What documentation is needed to validate payment? Sharpen your Auditing Skills – Group review of clinical documentation and coding for HCCs. Take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. See what your team should and should not be coding. Dates and Registration Links: Friday June 28 - https://lnkd.in/eNW7jDgw Friday, July 26 - https://lnkd.in/emS6nP9x Visit https://lnkd.in/esDVsekk to view all upcoming events.

CMS is sending out penalty notices for overdue Medicare #GADCS submissions. If your #EMS agency was supposed to report your data starting in 2022, but you haven't yet submitted, good news - CMS gave you a grace period. Confused about where to start, or just need a refresher? Get in touch or review our webinar, "Avoid the 10% Medicare Penalty: Best Practices for EMS Providers Now That Mandatory Cost Reporting is Underway." https://lnkd.in/evRWscGx

⚠️LAST CALL to submit comments to NCQA for the proposed 2025 standards! There are a lot of proposed changes that affect Health Plans and Credentialing / CVO organizations. ⏲️Credentialing timeframes will be significantly shortened across programs - mainly affecting those involved in Primary Source Verification (PSV). 📅Systems Control standards are not going away but some changes are coming that may add clarity ✅Get your feedback in by Monday (1/15) 💻If you have never submitted comments before it is quite easy - the system allows you to do so by selecting individual standards/ elements and you can comment on as many or few as you would like: https://lnkd.in/eDCjvifV #ncqa #accreditation #healthcarequality #performancemeasures #healthcareconsulting

And here it is … the CY2024 OPPS Final Rule was published yesterday late afternoon. I wanted to focus on the Hospital Price Transparency (HPT) portion. As expected, the rule is effective January 1, with a delay in parts that are more intensive for hospitals. Find the complete final rule here: https://lnkd.in/etyvwWxK 1. CMS finalized the requirement for hospitals to conform to a template for the MRF. This includes revisions to data elements to meet the template requirements. The use of the template is indicated as July 1, 2024. The current example templates will be revised to align to the final rule. 2. CMS finalized two changes to standardize how and where files can be accessed, and to improve the ability for CMS to automate audits and streamline enforcement. This is required January 1,2024: - requiring hospitals to place a ‘footer’ at the bottom of the hospital’s homepage to link to the MRF location - requiring hospitals to ensure that a .txt file is included in the root folder of the publicly available website 3. Hospitals will be required to affirm compliance. This will be included in the MRF template, for use after July 1, 2024. 4. CMS will streamline enforcement, and require acknowledgment by hospitals of any compliance actions and receipt of warning letters or corrective action plans. 5. Hospitals will be on display on the CMS website at any stage of review by CMS. 6. The changes to the price transparency requirements will be effective January 1. There is a phased implementation for hospitals to meet compliance and CMS enforcement. The proposed 60 day grace period was not adopted (shew!) As always, please reach out if you need help assessing compliance, creating a roadmap, development of your files, or want to just vent. #pricetransparency #cms #rationalpricing

Pinnacle is a proud sponsor of the Health Care Compliance Association (HCCA) Hawaii Regional Healthcare Compliance Conference in Honolulu, HI. Pinnacle Enterprise Risk Consulting Services Manager Amy Crenshaw-Pritchett, AAPC Fellow/Instructor CCS, CRC, CPA-RA, CPMA, CPCO, CDEI, CDEO, CASCC and Managing Consultant Angela Paine, CHC, CPC, COC, CPCO, CPMA, CPC-I will be presenting. Don’t miss their sessions! October 12th Medicare Advantage Changes for CY 2023: What You Need to Know at 8:30 AM with Amy Pritchett Key Takeaways: - Discuss the upcoming CY 2024 platform changes for Version 24 to Version 28 - Review Documentation guidelines and how the HCC change will affect #healthcare and ACOs - Define new #HCC categories and codes that will no longer risk adjust in the new model October 13th Improving Communication Across the Organization: Provider, Peer, Patient at 9:00 AM with Angie Paine Key Takeaways: - Learn to recognize communication styles - Discover how to connect for improved communication and outcomes - Takeaway skills to move from a difficult conversation to a productive one Stop by our booth to meet with Amy or Angie about their sessions, or to meet Principal and General Counsel Andrea Ferrari, JD, MPH and Associate Partner Kristen R Taylor, CPC, CHC, CHIAP to learn how Pinnacle can help your organization! #Medicare #coding #ACO

In this article, Aaron Wells, PhD, discusses issues, and a solution, for monetizing the value created by providers through their patient outcome improvement activities. This information is important to providers who are not fully capturing the financial benefits of their outcomes improvement work because they use methods the payer promotes instead of mutually agreed upon, rigorous quasi-experimental methods promoted by CMMI. https://bit.ly/3Lio2nS