Increasingly, reimbursement models are embracing pay for performance structures, where understanding the true health status of your membership is critical, thereby underscoring the importance of risk adjustment to plan success. Yet, health plans are making risk adjustment decisions using just 20% to 30% of available medical data which inevitably leads to inaccurate coding and unidentified risk.
Providence Health Plan historically relied on outsourced coding combined with chart chase activities to retrospectively code their ACA and MA populations. Recognizing the need for a paradigm shift, Providence embraced Natural Language Processing (NLP) technology to provide their risk adjustment team with access to all available information – including previously unavailable clinical data – in a comprehensive workflow for complete risk identification across multiple lines of business.
Webinar participants will learn about:
Who should attend: Health Plans with lines of business that require HCC coding methodology for reimbursement. In particular, plans with Medicare Advantage or ACA Exchange members will benefit from attending. Individuals with responsibility for diagnosing, coding, and/or managing risk-based revenue.
Rebecca A. Welling, Director Coding Compliance, Providence Health Plans
Rebecca Welling, RHIT, CCS-P has been the Director of Coding Compliance for Providence Health Plan for 10 years. Rebecca’s responsibilities include oversight of all risk adjustment programs pertinent to Medicare, Medicaid and ACA lines of business with focus on physician coding education, coder training and clinical documentation initiatives. Rebecca directs a team of highly trained HCC coders and educators that perform retrospective, prospective and RADV audits for all government related lines of business.
This work entails a thorough understanding of financial implications associated with an efficient and ethical risk adjustment program. Rebecca also serves in a consultative role for Providence’s Accountable Care Organization as part of the Population Health division. In addition to risk adjustment work, Rebecca oversees payment policy creation, appeal resolution and detailed coding applications for the Health Plan. Rebecca participates with AHIMA, and is a frequent speaker at AAPC and community events.
Providence Health Plan is a not for profit Health insurance company serving 650,000 lives in the Pacific Northwest. Providence Health Plan is part of Providence Saint Joseph Health, the third largest nonprofit health system in the US with services in Alaska, California, Montana, New Mexico, Oregon, Texas and Washington State.