MedCity News June 27, 2023
The traditional transactional approach to the coding of diagnoses to support billing in a fee-for-service environment is not adequate to meet the care requirements of VBC programs.
One of the primary goals for Medicare Advantage (MA) and other value-based care (VBC) programs is to effectively manage patients’ chronic conditions and avoid complications, including hospital admissions and re-admissions, and costly interventions. To accurately compensate providers for the care of these patients, VBC programs rely on clinical risk scores based on the diagnoses for which a patient is receiving care.
However, while it may seem like a straightforward process, finding and documenting the information required for accurate VBC risk assessment is not always easy.
Consider Medicare Advantage, which has defined approximately 80...
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