How to Improve Medicare Risk Adjustment Scores

Posted by Lucy Medina on Sep 1, 2020 12:01:59 AM

As enrollment in Medicare Advantage plans grows, healthcare organizations need to be able to predict future healthcare financial resources and appropriate reimbursement. The Hierarchical Condition Category (HCC) risk adjustment model is used by CMS to estimate predicted costs for Medicare Advantage beneficiaries, and the results directly impact the reimbursement healthcare organizations receive. 

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Topics: Medicare, hcc coding tools, hcc coding technology

Impact of Coronavirus for Healthcare Providers:  Billing & Coding Operations

Posted by Lucy Medina on Apr 3, 2020 4:38:36 PM

Doctors using computer looking at files in medical office-1

The situation in the US with COVID-19 has continued to escalate day by day. Healthcare providers are at the front line of this challenging situation that is impacting the healthcare system in unprecedented ways. In these times of uncertainty, healthcare providers have many moving pieces to worry about, today we will focus on the documentation aspects of the novel coronavirus. 

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Topics: Medicare, hcc coding tools, hcc coding technology

Updates on Medicare's Telehealth Coverage During the Coronavirus Crisis

Posted by Lucy Medina on Apr 1, 2020 1:49:37 PM

Doctor working at the hospital on a laptop and holding x-ray

On March 6, congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. This new rule allows healthcare providers to bill Medicare fee-for-service for patient care by Telehealth during the current coronavirus pandemic crisis.

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Topics: hcc coding tools, hcc coding technology

CMS Proposed Interoperability Rule: Where is it at?

Posted by Lucy Medina on Mar 3, 2020 1:43:16 PM

Medicine doctor hand working with modern computer interface as medical concept-1

CMS Proposed Interoperability Rule: Where is it at?

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Topics: hcc coding technology

HCC Coding Technology in the New Year

Posted by Lucy Medina on Jan 27, 2020 10:03:15 AM

hcc computer image

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Topics: risk adjustment, hcc coding tools, hcc coding technology

Driving Provider Engagement in HCC Coding  and Risk Adjustment

Posted by Lucy Medina on Dec 16, 2019 11:22:20 AM

Concentrated medical team using laptop together in the office

Despite the fact that revenue from risk-based contracts continues to increase for medical groups of all sizes, motivating providers to fully participate in their organization's risk adjustment efforts remains a challenge for healthcare organization leaders. Because of this, many organization leaders have started looking for different ways to motivate their teams of providers to drive better engagement in HCC Coding & risk adjustment documentation. In our first blog post of this series, we discussed the importance of HCC coding and optimal documentation, its challenges, and the role of the individual provider. 

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Topics: HCC coding, hcc coding tools

The Changing Role of the Provider in HCC Coding

Posted by Lucy Medina on Oct 3, 2019 11:46:08 AM

HCC Coding Tools

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Topics: HCC coding, hcc coding tools

Healthcare data interoperability and open skies: At last some help from the government!

Posted by Sunil Nihalani, MD & CEO on Apr 3, 2019 12:12:14 PM

doctor hand drawing  with modern computer interface as medical concept


In February of this year, the ONC and CMS proposed a new interoperability rule that promises to be a game-changer for patients, providers, and software developers like us. Given that the federal government has spent tens of billions of dollars trying to get clinical providers on the electronic health record (EHR) bandwagon with, questionable results at best, it’s a case of better late than never. Here is my perspective as CEO of a clinical decision support startup that stands to benefit from the rule, once it is implemented.

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Topics: Improving Healthcare, Start ups

How technology can help accurate HCC coding

Posted by Sunil Nihalani, MD & CEO on Dec 9, 2018 7:03:01 PM

Medicare Advantage plans use Risk Adjustment Factor (RAF) scores to determine patient care expenses. The RAF is therefore a benchmark that enables the Centers for Medicare & Medicaid Services (CMS) to estimate future spending. With higher RAF scores, the amount Medicare pays Medicare Advantage plans for patient care also increases. Ultimately the goal is to improve patient outcome with reduced costs. Risk adjustment can also affect physician income. More recently, Medicare is using the HCC model to allocate costs for patients in Medicare Accountable Care Organizations.

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Topics: HCC coding

What You Need to Know About Infera CDSS for Athenahealth's Clinicals

Posted by Suraj Bhan on Nov 29, 2017 12:18:20 PM

What should Athenahealth users know about Infera?

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Topics: Clinical Decision Support, EHR, EHR Integration, EMR, Inferscience News, athenahealth, CDSS, Improving Healthcare

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About Inferscience's Founder

With over 12 years of experience working with electronic health records (EHRs), Dr. Sunil Nihalani observed how EHRs are being under-utilized in clinical practices. Moreover, the HCC Coding & risk adjustment coding capabilities have been lacking in the clinician’s workflow. Dr. Nihalani’s vision is an HCC Coding tool solution that integrates with leading EHRs and HIT systems to analyze patient records and claims information to help physicians and coders capture and audit HCC codes within their workflows. With Inferscience’s HCC Assistant, Physicians can document HCC codes and plan of care information in real-time during the patient encounter. Now, one solution enables both payers and providers to succeed in today's value-based care market.

Learn more about Inferscience and HCC Coding Assistant by visiting our products page here.