Wednesday, June 19, 2013

The Creative Destruction of the RADV Audit

Kameron Gifford, CPC          6/19/2013

How much does your company spend outsourcing chart audits and education? What if you could “dump” all of those medical records into a program that would identify only the records with deficient or incomplete documentation? What if that same program could then design and build an individualized, interactive mobile platform targeted to those deficiencies? A single secure dashboard that can track and monitor compliance and progress all in one place. What value could this create for the Senior VP managing 17 markets in 6 states or the Managing Director responsible for 91 centers? How could this positively affect provider buy-in and add transparency to risk adjustment initiatives? Ultimately, how much money could this disruptive innovation save your organization?

I am a certified coder, who specializes in risk adjustment coding and clinical documentation improvement. This unique skill comes with its own unique set of challenges. Due to the Government’s recent assault on our industry my services are in great demand. This in itself is great news, except that the current process of auditing is inefficient and redundant.

The “digital” age has completely modified our entire culture. Consumers want more, bigger, faster, better, smarter and all for less money. Technology has transformed and altered society to a point of dependence. We can all relate to that “terrifying moment when we reach for our cell phone and it’s not there. Who would have predicted 20 years ago that this “phone” would replace our alarm clocks, travel agents, mail, books, televisions and computers?

Until recently, the healthcare industry has been isolated, shielded from the chaos of disruptive innovation that has transformed every other industry. But today that separation barley exists, and we are seeing more and more tech companies entering the healthcare space. This collaboration yielded the first electronic medical record and delivered the first computer assisted coding programs. But the healthcare industry has yet to be profoundly touched by any of these inventions.

As an industry, we must take heed to what lies ahead. We must learn from the error of those around us and continually strive for something better. We must promote “the right way” and stop allowing the court system to influence the practice of Medicine in America.
How can we use new technology to assist us in our compliance and due diligence responsibilities in terms of HCC Coding and Documentation? How can we engage and excite our providers? How do we build an “on-demand” teaching system that focuses on improving documentation specific to risk adjustment rules? What if we designed a mobile teaching platform available to all clinicians at the point of care. What value would this add on the back end for auditors and educators as a way to “sort” massive amounts of records and triage providers in order of need? What if the government stopped finding “fraud” and was unable to demand recoupments fines and penalties?

The entire delivery of care as we know it, is about to be disrupted. Contact ERM today to find out how you can be part of it.


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