Clarice Smith

Vast changes are coming to Medicare Risk Adjustment. Is your team ready? Workshop Agenda: ­Discuss the importance of managing HCCs year over year. What resources are available from CMS to help? When is the Advanced Notice published? What are the components of a risk score? How will CMS calculate risk scores for 2025? Review NEW and updated HCCs. What documentation is needed to validate payment? Sharpen your Auditing Skills – Group review of clinical documentation and coding for HCCs. Take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. See what your team should and should not be coding. Dates and Registration Links: Friday June 28 - https://lnkd.in/eNW7jDgw Friday, July 26 - https://lnkd.in/emS6nP9x Visit https://lnkd.in/gjJZfKhV to view all upcoming events.

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Stay alert, #MA friends! #CMS Administrator Brooks-Lasure told a crowd at an AHA event yesterday the agency is taking on Prior Authorization in #MedicareAdvantage next. Now that their focus on Sales and Marketing is codified, CMS is paying close attention to the stories and complaints they receive about Prior Auth, researching them, and asking for data through RFIs to ensure their conclusions and decisions are data-driven and effective. Word on the street is that politicians on both sides are rallying harder around Prior Auth reform than many other topics as they, and their own families, experience denials, delays and other barriers to care caused by PA. If we've learned one thing in DC, the more personal it feels to decision makers, the more likely we'll see action. Pro Tip: CMS also reminded plans they can change their policies without waiting on agency action. #LeadersDontWait on regulations to make change happen! #NotBusinessAsUsual

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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⚠️ Top High-Risk Compliance Zones in Healthcare ⚠️ Do you know where your compliance risks are highest? Our comprehensive guide identifies the top high-risk zones in healthcare and provides strategies to mitigate them. 🧐 Assess your preparedness and gain actionable insights to enhance your compliance efforts. 📖 Read more: Top High-Risk Compliance Zones in Healthcare. https://lnkd.in/eRwkU3Qn

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Is your organization prepared for extended downtime in today's cybersecurity landscape? ComplyAssistant's DRBC Consulting Services are here to ensure you are! Our team understands the evolving threats like ransomware attacks, which can extend downtime to 30 days or more. Traditional DRBC plans might not cover these scenarios adequately. Don't wait until it's too late. Contact us today to strengthen your DRBC plan and safeguard your organization's continuity! 💪🔒 https://lnkd.in/e6zvaX3i #DRBC #Cybersecurity #BusinessContinuity #RansomwareProtection

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