Value-Based Care Blogs | DoctusTech

Why one letter of MEAT isn’t enough to prove compliance in value-based care

For years, compliance wasn’t prioritized because the system rewarded speed and volume over documentation depth. That used to be fine until audits started asking tougher questions. Many organizations still teach that any one letter of MEAT is enough to prove compliant documentation. But if an audit lands on a note that says only “stable” …

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Medicaid audits: What value-based care leaders need to know

If your organization is in value-based care, chances are you’re juggling multiple lines of business, including Medicare Advantage, Medicaid managed care, Medicare Shared Savings, and possibly even fee-for-service. But here’s the trap many leaders fall into: focusing all compliance energy on Medicare Advantage, while leaving other contracts exposed. And that’s a costly mistake. Medicaid …

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Understanding Recovery Audit Contractors (RACs): Can they impact your value-based strategy?

Most value-based care organizations center their compliance programs on Medicare Advantage, and for good reason. Risk adjustment in MA drives financial performance, and documentation gaps there can quickly undermine revenue. But RAC audits are a reminder that liability does not stop with MA. Providers also carry exposure in Medicare fee-for-service, Medicaid, and other lines of …

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How VBC delivers on the quadruple aim

When we talk about optimizing health system performance in the value-based care (VBC) model, it’s common to refer to the quadruple aim: improved patient outcomes, improved patient experiences, improved provider experiences, and reduced costs. And the best way to determine whether or not the VBC model is delivering on these aims is to talk to …

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Why does accurate HCC coding matter?

Clinicians and other medical staff find it hard to care about HCC coding. Here’s why they should. Selling clinicians on the value-based care (VBC) model should be straightforward. In theory, it promises more time with patients per encounter – with a greater focus on patient outcomes when compared with the ‘numbers game’ of fee-for-service medicine. …

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Exploring blended payments

We asked VBC thought leaders to share their experiences of fee-for-service and value-based reimbursement models. While value-based payment models are on the rise in the U.S, primary care practices still receive the majority of their payments via fee-for service. In 2022, 70% of primary care physicians reported receiving fee-for-service payments, versus just 46% for …

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Risk, Revenue & Care: How HCC coding and RAF impact Value-Based Care Revenue and Patient Outcomes

The basics of RAF and how it is calculated. Total HCCs for a single patient equal RAF score Every VBC patient has a Risk Adjustment Factor (RAF) score, and the score follows the patient. The more medically complex diagnoses render a higher RAF score. The higher the score, the more resources required to care …

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Value-Based Care Revenue and Outcomes: Impact of HCC Coding and RAF

Diagnosing for risk in VBC is the unsung hero fixing healthcare behind the scenes. In this blog, we dig into diagnosing for medical complexity & documenting with ICD-10 codes. Diagnosing for medical complexity Physician diagnoses patients with all medical conditions. One shift when transitioning to Value-Based Care is the need to diagnose very …

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How HCC coding and RAF impact Value-Based Care Revenue

The relationship between medical complexity, documentation, risk, innovation, and revenue is actually far more simple than it sounds. We are often asked very broad questions about how all of the moving pieces of VBC work together. How does highly specific and accurate diagnosing with HCC codes relate to patient care? Do HCC codes help …

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VBC Industry Insights From HCP-LAN’s Annual Report

Values-based healthcare reimbursement has been adopted more quickly in some healthcare sectors than in others. According to the LAN’s latest APM Measurement report, 40.9% of US healthcare payments—representing over 238 million Americans and more than 80% of the covered population—were generated through value-based reimbursement programs last year. Population-based payments and downside risk agreements were …

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How Hospitals Can Tackle Surges With Value-Based Care

With the flu season ramping at unprecedented rates, and a new surge of RSV coming when COVID-19 numbers are rising again, the topic of a healthcare surge emergency is back in the headlines. What the New York Times is calling a “Tripledemic” is threatening to overwhelm providers and hospitals yet again. During the peak of …

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DoctusTech Helps: Change Clinician Behaviour

According to the American Journal of Managed Care (AJMC), the least effective method for continuing medical education (CME) for clinicians is distributing printed materials: emails, PDFs, flyers, email blasts, and so on. Many medical professionals believe that clinician education should be concerned with encouraging continuous development rather than simply raising consciousness. What, then, are the …

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DoctusTech Helps Value Based Care

Value-Based Care is a natural movement toward the benefit of the patient with a reduction in costs by aligning all incentives in the right direction. And as providers make the shift, patients will be encouraged both by the motive behind the transition as well as the improvement in their overall health and the reduction in …

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DoctusTech Helps: Increase RAF Accuracy

“I don’t care if the RAF goes up or down, I only care if it’s accurate.” Dr. Farshid Kazi, Co-Founder, DoctusTech If an organization is caught over-coding, up-coing, diagnosing conditions that either do not exist or are not supported in the chart, the cost of these errors can be very high. Audits are no …

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Amazon Announces Plans to Buy OneMedical

Amazon has announced plans to buy OneMedical for $3B. OneMedical is a brick and mortar plus digital healthcare marketplace that operates in several major U.S. markets. The acquisition is Amazon’s latest move in the healthcare sector, and analysts say it could be a sign of bigger things to come. This is not Amazon’s first foray …

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DoctusTech Helps Clinicians Learn HCC Coding

DoctusTech Helps Clinicians Learn HCC Coding

DoctusTech helps clinicians learn HCC coding through clinical vignettes in an app that is fun and engaging. Diagnosing with the appropriate HCC code is a critical skill for modern clinicians who care for patients in a value-based care arrangement. You cannot treat what you do not accurately diagnose, and you cannot afford to treat what …

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Everything You Need To Know About HCC Coding Training

Everything You Need To Know About HCC Coding Training

Why is HCC coding training important? Without proper coding, it is impossible to diagnose accurately, treat effectively, document those diagnoses, or achieve revenue goals. Coding training will help you master the skills you need to properly code patient records, so investing in HCC coding training might be the right move for you! Read on to …

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Risk Adjustment Coding

Risk Adjustment Coding – Challenges And How To Get It Right

Risk adjustment coding is a vital part of any managed care organization. It helps to ensure that patients are appropriately diagnosed and documented accurately according to risk level, which in turn allows the organization to receive appropriate capitated payments to provide all the care needed to reduce avoidable hospitalizations and achieve maximum health. And regardless …

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The Intricacies of Value-Based Care: A Step by Step Guide

Value-Based Care is a game-changing advancements for patients and the providers who care for them. Value-based care is revolutionizing the healthcare industry and aligning incentives more and more each year. The concept of pay-for-performance, patient-centered care, and outcome measures have all been developed with the intention of providing more value to patients and healthcare providers …

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OIG 13 percent of Medicare Advantage Prior Authorizations Inappropriately Denied

OIG: 13% of Medicare Advantage Prior Authorizations Inappropriately Denied

The Office of Inspector General is cracking down on Medicare Advantage prior authorizations that were denied which would have been approved under fee-for-service Medicare rules. Excerpts from the OIG Medicare Advantage prior authorizations denial report follow, quoted in full, arranged for clarity, and followed by our comments. The OIG audited “a stratified random sample …

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4 KEY HCC Coding Challenges Clinicians Face

4 HCC Coding Challenges All Clinicians Face

As the U.S healthcare system transitions towards value-based payment models, independent clinicians and physician groups continue to face HCC coding challenges that not only impact their bottom-line, but patient care as well. On top of all this, the pandemic has added a significant burden to the already stretched clinician workload. Here are 4 key …

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HCC Coding and Physician Burnout

HCC Coding and Physician Burnout

RaDonda Vaught was just sentenced to three years of supervised probation. The former Vanderbilt University Medical Center nurse was found guilty of negligent homicide and gross neglect of an impaired adult in the death of a patient, because she administered vecuronium rather than Versed. A tired, overworked nurse could not find the prescribed medication …

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Value-Based Care

Implementing Value-Based Care – A How To For Physicians

Implementing Value-Based Care is essential for today’s physician. Value-based care is a system of payment and reimbursement that rewards healthcare providers for delivering high-quality, cost-effective care to patients. There are two ways to improve the value of care: improving the quality of care (fewer complications, less re-hospitalization, shorter length of stay, better patient experience); and …

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A Quick HCC Coding Knowledge Hack

Looking for a quick HCC coding knowledge hack? Use this Quick Guide to identify HCC codes for risk adjustment. Diagnosis coding for value-based payment models is one of the key drivers for innovation in modern healthcare – aligning incentives with care in ways that were only talked about in decades past. However, without appropriate and …

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Healthcare Industry Shift Toward VBC

Healthcare Industry Shift Toward VBC

It has long been thought that the machinery of the US healthcare system is so big, so complex and so established that steering the ship is nearly impossible. However, if we’ve learned anything from the COVID-19 pandemic, we can be nimble when we have to be. Lives were on the line, the nation itself was at …

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Full Risk Value-Based Care

The Market Is Moving Toward Full Risk Value-Based Care

The US healthcare market is leaning in the direction of Full Risk Value-Based Care. While the system is often characterized as a monolith; a massive, unwieldy machine (and as immovable objects go, it is a big one), that big machine is trending steadily toward full risk value-based care. The CMS recently reported that total …

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The Rise of Risk - HCPLAN APM alternative payment model Framework- Value-Based Care Payments Increasing

The Rise of Risk: Value-Based Care Payments Increasing Year Over Year

As we look forward to the release of ACPLAN’s 2022 Alternative Payment Method report, let’s review data from their previous six annual reports. One clear takeaway is that Value-Based Care payments increasing year over year is a trend that shows no signs of stopping. Trend lines point to the inevitable rise of Full Risk, but …

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HCC Coding Education For Family Physicians.png

HCC Coding Education For Family Physicians – AAFP

Specificity and accuracy are the keys to any successful Value-Based Care program. And clinical vignettes are a great way to learn. Five years ago, the AAFP (American Academy of Family Physicians) published a crash course to educate family physicians on HCC coding. To this day, the clinical vignettes from this family physician HCC coding …

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HCC coding education for doctors: The easy way

Requiring clinicians to learn one more thing—especially when HCC coding does not feel connected to treating patients—is a big ask. Expecting them to learn in ways that are both ineffective and profoundly dull is just plain cruel. Doctors talk a lot about behavior change in patients. But behavior change in doctors is incredibly tricky …

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HHS secretary Xavier Bacerra on overcoding in medicare advantage

HHS Secretary Becerra Addresses Upcoding in Medicare Advantage

In Friday’s “State of the Department” address, HHS Secretary Xavier Becerra spoke candidly about upcoding and overcharging in Medicare Advantage. After offering prepared remarks on the continuing COVID public health emergency, Robert King of Fierce Healthcare asked very pointedly about upcoding in Medicare Advantage. Secretary Becerra answered with few specifics, but a clear directive that …

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ACO REACH DCE CMS

ACO REACH Model Replaces GDCP (DCE) Model – But What Really Changed?

CMS recently unveiled their replacement for the Direct Contracting Model (DCE), renamed now as the ACO REACH Model. Many of the original Direct Contracting Model tenets will remain the same, with a few significant changes announced. From heightened scrutiny on up-coding and documentation accuracy to improved Access and Equity, the new model looks to improve upon …

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VBC Strategies for 2022: What to STOP, START and CONTINUE?

Levi Wiggins: Alright. Here we are. Live with Dr. Kazi for Year End Preparation for 2022: things to stop doing, things to start doing and things to keep doing. Our host, as always, is Dr. Kazi. Give us a brief introduction! Farshid Kazi, MD: Thank you everybody. Farshid Kazi, internist by training, with …

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ACOs Risk adjustment coding in medicare shared savings program HCC MSSP

How the MSSP Rule Reshapes Risk Adjustment Coding for ACOs

Quick glossary CMS = Centers for Medicare & Medicaid Services MSSP = Medicare Shared Savings Program ACO = Accountable Care Organization HCC = Hierarchical Condition Categories RAF = Risk Adjustment Factor CMS released its final Medicare Shared Savings Program rule, called Pathways to Success, for ACOs. The new rule is designed to help establish …

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Value-Based Care Contracting 101

Value-based Care Contracting 101

Value-based care (VBC) contracting lays the financial foundation for every VBC program. Unlike fee-for-service models, these contracts reward providers for quality, outcomes, and cost savings, aligning economic incentives with patient care. However, fee-for-service contracts continue to be a challenge for VBC. The pandemic led to a drastic volume reduction, which impacted FFS contract revenue …

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