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.
Webinar participants will learn:
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.
Mary Beth Jenkins, Senior Vice President & Chief Operating Officer, UPMC Health Plan
Adele L. Towers, MD MPH FACP, Senior Clinical Advisor, UPMC Enterprise
Key takeaways and lessons learned that can enable your organization to succeed in similar circumstances.
Pre- and post-technology enabled coding workflow, NLP suggestions and analytics that transformed operations.
Results which demonstrate: visibility, 4x gain in coder productivity, and increase in RAF capture.