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As coders prioritize codes that impact reimbursement, important information could be lost. “In In the long run, we need a good understanding of exactly what conditions and risk factors and other aspects are affecting hospitalizations and patientcare outcomes,” explained Bowman.
As coders prioritize codes that impact reimbursement, important information could be lost. “In In the long run, we need a good understanding of exactly what conditions and risk factors and other aspects are affecting hospitalizations and patientcare outcomes,” explained Bowman.
But momentum will continue, since the Centers for Medicare and Medicaid Services (CMS) announced in 2021 that it plans to transition fully to value-based reimbursement by 2030. Why the change to value-based care? Providers who join an accountable care organization (ACO) or bundle services assume some financial risk.
Through enhanced coding and charge capture, these algorithms analyze clinical documentation to propose precise medicalcodes, minimizing the risk of undercoding or overcoding while ensuring comprehensive coverage of billable services. Published online April 28, 2021. Information Systems Frontiers. doi: [link]
Regular compliance audits help organizations provide the most efficient, effective patientcare. As a result, the Centers for Medicare and Medicaid Services (CMS) public rule on price transparency requirements for hospitals came into effect on January 1, 2021. But they can also be a source of stress and frustration.
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