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.
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.
The PAMA (Protecting Access to Medicare Act 2014) law signed by president Obama and passed in April 2014, mandates that physicians consult appropriate use criteria (AUC) before ordering advanced imaging tests. While originally intended for implementation on January 1, 2017, Medicare has postponed the implementation for now, but given the spiraling costs of healthcare, we can be certain that sooner or later providers will need to show that appropriate use criteria are met for advanced imaging tests.
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.