Cracking the Code to Better Quality and Financial Outcomes
1:30pm - 2:30pmTuesday, February 12
Orlando - Orange County Convention Center
One of the greatest challenges facing hospitals is their increased assumption of risk as a result of the transition to value-based care. Rather than allowing providers to drive revenue by raising their volume of services, both CMS and commercial payers are now moving to base provider reimbursement on quality outcomes and scores. Since it costs more to deliver proper care to patients with more health issues, CMS introduced risk adjustment factors (RAFs) to compensate providers for this increased level of care, which brought a host of challenges around documentation accuracy. Faced with these challenges, Rush University Medical Center sought new ways to improve risk-based revenue and elevate quality scores. Among the most important was an initiative to boost premium revenues through accurate HCC code capture, which enabled Rush to take on more high-risk covered lives. The program resulted in increased revenue of $2,300 per patient, or about $20 million per hospital annually.