How Intelligent Analytics Increase Quality and Lower the Costs of Risk Adjustment Programs

Medical coding is the backbone of risk adjustment. Coding needs to be efficient and accurate to keep up with the increasing  influx of sensitive patient data, and CMS regulations. Budgeting for risk adjustment processes is challenging for healthcare providers and health plans alike.  Efficiencies, accuracy, and regulation all play a major role in budgeting for CMS reimbursement and all can wreak havoc on the financials. 

Many healthcare organizations choose to hire third-party vendors to manage everything from housing the chart data to coding the assets. In this system, external coders are typically paid per completed chart, and there is little way to check on their productivity. Analytics can help ealthcare organizations with either external or internal coders’ productivity and help  to increase efficiency and accuracy.

Data analytics technologies utilize databases that are continuously updated with new medical codes, and their ability to track documentation gaps helps remove the risk of human error. With technology, healthcare organizations own the data assets and have direct visibility into coding performance and accuracy. This level of control allows organizations to improve results while reducing coding costs. 

Transition to an Hourly Pay Rate for Coders

Implementing patient analytics technology helps speed up the medical coding processes. The technology, which uses its vast database to scan for patterns and identify codes that differ from the norm, eliminates the need for coders to manually comb through charts. As coding productivity increases, the coders are able to take on more work in the same amount of time. The technology is designed to accelerate coding while making it easier to track the work coders complete. 

With the added visibility into coding performance that technology provides, organizations are then able to alter their payment rate. They can pay coders on an hourly basis rather than a per-chart basis. Thanks to the assistance of technology, productive coders will be able to complete more charts in less time. With clear visibility into individual coder’s accuracy, efficiency and output, an hourly pay rate becomes the most logical and cost-effective solution. 

Leverage with Vendors 

Having ownership of data assets has several benefits. For starters, you are able to control the implementation of the technology and the data security. The vendor no longer houses the chart data, therefore their charges to accommodate data security disappear and your bills decrease. You will then be paying less for your third-party vendors, and you no longer have to worry about whether or not they have the right security protocols in place for coders. 

With full control over your data and technology, you have some leverage over the amounts that you pay external coders and any other outside organizations. Your payments are simplified and all you have to worry about is paying the hourly coding rate. 

Complete Transparency 

When you have full visibility  into the productivity of medical coders, you are able to hold coding vendors accountable to their agreements.. With this insight, you can more easily identify low-performing coders and replace them with more productive ones. 

You can set the standards for your service and ensure that your vendor meets the quality that you and the CMS expect. If the vendor is not meeting your standards, you can find a new vendor. This transparency can drastically improve coding accuracy, as well as the cost benefits that accurate coding brings with it. 

Attract Top-Quality Vendors

When vendors know that you are serious about coding accuracy and efficiency, those that have similar standards will step up. It’s best to work with vendors that see themselves as part of your team and work with you to achieve a larger goal of compliance. Also, companies that are okay with you having full visibility of their performance are more likely to stand by their quality and productivity. 

Identify Errors and Fix Them 

Documentation gaps and errors happen; it’s just part of the medical coding process. But, healthcare organizations with the right technology can view where the errors are taking place at the provider level. rends become evident  and organizations can then create plans to educate providers on how to avoid these mistakes. 

By identifying coding errors where they first take place, you are then able to save time and money later with the medical coding team. The coding accuracy will also be improved, as there is less chance of errors coming down the pipeline and being missed. Visibility allows you to track problems and amend them before they ever reach your team of coders. 

If you are interested in lowering the cost of risk adjustment while increasing quality and coding accuracy, you need to partner with a patient analytics technology that provides you with the necessary visibility and predictability.