In response, our friends at the Centers for Medicare & Medicaid Services (CMS) stepped up to encourage healthcare providers to adopt telemedicine visits to deliver virtual care in the absence of in-person medical visits. However, telehealth flexibility also increases concerns about potential fraud, waste, and abuse (FWA) and there will undoubtedly be some downstream reverse engineering by CMS to mitigate these inherent risks.
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We have seen an exponential growth in the number of telemedicine visits being performed since the pandemic’s arrival on our shores. While this growth is expected to plateau, telemedicine is here to stay well beyond the pandemic. A recent article by Becker’s Hospital Review, “Trump directs federal agencies to make telehealth reforms ‘totally permanent,”(1)
Telemedicine has exploded out of necessity to address healthcare needs amidst stay in place constraints, but it’s created new reimbursement changes especially for the value-based care market. This is the first in a series of five…
The American healthcare industry will undergo significant disruptions as the coronavirus crisis penetrates the American landscape. Three critical events are already affecting the Risk Adjustment operations process at America’s health plans for 2020.
Second-Level Review with NLP-Enabled Technology Will Boost Coding Accuracy Machine learning technology and advanced natural language processing can detect and extract HCC codes that were missed or miscoded during first-level reviews. Missed codes identified on a second-level review can result in millions of dollars in additional reimbursement for health plans while also improving RAF score accuracy.