An article in Modern Healthcare magazine reported that physicians who serve low-income patients with complex conditions are more vulnerable to financial losses in value-based payment models. The study that found these providers, many of them safety-net providers, didn't have the technological infrastructure to report the necessary data.

 

The report, published in JAMA, found that physician practices with a large proportion of high-risk patients were likely to receive a penalty in the CMS' Physician Value-based Payment Modifier program because they reported low quality outcomes and higher costs.

 

The study analyzed 2015 payment data from the CMS' Physician Value-based Payment Modifier program made to 899 physician practices who treat 5.2 million Medicare beneficiaries. The mandatory pay-for-performance program penalized or rewarded physicians based on their quality outcomes and cost of care. The program was a precursor to and was replaced by the Medicare Access and CHIP Reauthorization Act (MACRA).

 

To evaluate the level of patient risk among practices, the study used the Hierarchical Condition Category (HCC), a risk-coding model that adjusts for different demographics and conditions and whether patients were dually eligible for Medicare and Medicaid.

 

The study found that practices categorized as high-risk were more likely to receive a penalty compared to low-risk practices because they didn't provide the necessary performance data for the program during its first year. About 45.9% of high medical and social risk practices were penalized while only 20.8% of low-risk practices were penalized for not reporting the data.

 

To overcome this challenge, high medical and social risk practices need to take advantage of coding outsource experts who can help them code and report the data necessary to avoid these penalties. Aviacode can provide a comprehensive accuracy review of coding related, billing and reimbursement practices aimed at identifying potential problems in HCC risk adjustment coding.

 

Our experienced and credentialed auditors are compliant with the latest coding guidelines and changes to ensure that all coding is accurate, consistent, comprehensive, and will pass any audits.

 

Aviacode uses the best credentialed and experienced coders in the industry. All of our coders are AAPC or AHIMA certified, have years of experience, and are continually working to improve their productivity and to stay on top of changes in rules and regulations.

 

Aviacode auditors utilize ProAuditor software, our proprietary application developed to streamline and standardize audits, and provide audit results that are actionable and easy to understand. ProAuditor, along with our expert auditors, provide a powerful combination to help identify corrective actions, and provide support and training to make them happen. We offer chart audits to any size organization, from stand-alone physician clinics to multi-site hospital facilities.

 

If your practice serves low-income patients with complex medical conditions, let Aviacode help you with your coding and coding audits to avoid coding denials.