Why Does
Coding Count?
Coding
Accuracy–We are all
required by HIPPA to follow the International Classification of Diseases (ICD)(ICD-10
October 1, 2015) coding guidelines. This includes compliant code selection and
documentation to support codes reported. The health care system and the
patients count on the providers to assist with showing medical necessity.
Risk
Management–Health plans
are reimbursed based on providers’ code submission on claims. Codes need to be
reported to the highest level of supported specificity so correct payment is
received, and hold if in case of an audit of coding versus documentation.
The system counts on providers to assist in keeping risk low by coding their
best.
Quality of
Care–Medicare Advantage
plans are ranked by CMS on a star rating scale of 1 to 5. Factors within the
quality scale directly relate to codes reported and supported on the provider
level. The higher the star rating, the better recognition the health plans
receive from Medicare. Providers are
scored on the performance for: MRA and/or
HEDIS. Physicians that deal with traditional Medicare, their scoring is based
on PQRS.
Today’s healthcare
requires a physician to be more involved in the administrative aspect and the
quality of care rather than patient care.
A provider now has to be concerned with:
·
PQRS
·
HEDIS
·
Meaningful
Use
·
Quality
Measures
·
Core
Measures
Pending how the provider performs on these scores:
·
It will determine his/her contract(s) with
Health Plans
·
Failure to comply will result in a payment
reduction
·
Failure with Risk Management / Capitation
·
Audits
We are proud to introduce MCAR REPORTS a complete set of management
reports for IPAs, MSOs and PCP Practices that have Risk Agreements with HMOs
Plans. The MCAR Reports give you complete awareness over what is happening with
every HMO Plan that your organization participates in risk operations.
MCAR - MANAGED CARE REPORTS is an online service available created from data
files downloaded from HMOs servers. Within 24 to 48 hours our team produces all
reports needed to manage your risk business. MCAR Reports are viewed from our
secured HIPPA compliant servers however most reports are downloadable in EXCEL
format files.
MCAR Reports services can range from only generating reports to having
our management team assisting clients in managing the risk operations.
Clients can select MCAR Report services “A LA CARTE” choosing monthly
reports needed and/or consulting services they prefer.
FOR MORE INFORMATION PLEASE CONTACT:
HPP Management Group, Corp.
Developers of the AccuChecker Product Line
Phone: (305) 227-2383 or 1-877-938-9311
Email: fcortes@hppcorp.corp
