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.
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.
Topics: HCC coding
What should Athenahealth users know about Infera?
Down in the trenches of Medicare Advantage primary care, most providers in the business know the importance of HCC coding. However, for the busy practitioner who is taking care of the patient and dealing with an alphabet soup of mandates such as HEDIS, STAR, HCAHPS etc, it is quite a task to pay attention to HCC coding in real time. As a result, providers fall short and have to answer then queries from coders re HCC codes that may have been missed.
As CEO of a startup whose main product provides advanced clinical decision support (CDS), I read with interest the draft guidelines for CDS software that The CDS Coalition came out with recently. I was also curious to see how our application, Infera, stacks up against the guidelines. I am happy to report that it stacks up really well. Read on for more details:
Topics: Improving Healthcare
Inferscience is proud to announce the release of an innovative new technology for optimal HCC coding at the point of care in real time. The HCC Assistant was designed to optimize accurate and real time documentation of the patient conditions critical to predicting the risk and future cost of Medicare Advantage patient populations.
In healthcare, we’re accustomed to things moving slowly. But every so often, trends accelerate and leaps are made, for better or sometimes worse. Recent news from two large EHR vendors about the adoption of open APIs signals an encouraging trend.
The term “clinical decision support” (CDS) has been used for a long time to describe many different mechanisms offering clinical knowledge to clinicians in the clinical setting. But most organizations utilize solutions that deliver what can best be described as “passive support” requiring both user initiation and a lot of extra work for the clinician.
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.