Is your organization currently taking on risk or participating in value-based payment models?

If so, we can help! 

ERM Consulting will work with your team to develop an internal risk adjustment program. 

Services Included:

• Remote Auditing and Monitoring - Review of 25 encounters per provider, per month, with detailed monthly reports to track error trends and validation rates. 
• Development of Custom Education - Custom education for providers and coders, every quarter, to reinforce positive changes and educate on new opportunities. 
• Onsite Meetings (One week on-site per Quarter) - 1:1 meetings with providers, coders and leadership to review current audit results and discuss opportunities for improvement. 
• Oversight and Guidance - ERM will provide oversight and guidance to assist with the development of development of internal team and processes needed to manage new payment models. 

Strategic Considerations:

1. Who will be part of the team and what role will they play? 
2. What new processes need to be added or adjusted?
3. How will the team communicate and measure success?

Who is On-boarding, Training and Managing your Coders?

ERM also offers remote on-boarding, training and management of coders and billing teams. 

• Visit ERM online or email for more information.

Contract during the month of December and receive a 25% Discount – on all HCC Coding Tools by ERM – visit our online store at https://erm.ecwid.com/ to see a complete list.

Is Your Team Risk Ready?

What will define those who claim victory and those who are defeated in the battle towards value based care? Will it be those organizations with the most money, power and seats at the table? Or will it be those who are nimble, flexible and open to change?

 I believe it will be both. As victory will not be defined by the owners and head coaches but instead by how the players execute on the field. It will be the game time decisions that matter most.

A quarterback who can read the defense and adjust accordingly will provide far greater value to the offense than the most athletic quarterback who misses the blitz every time.

Perhaps Napoleon said it best, “Battles are won by the power of the mind.” For in a game of inches, the winners and losers will be defined by those who can execute in the moments that matter most.

Prepare your team for victory with information at the point of care!

ERM Consulting has developed the industries best tools for players on the frontline.

Order yours today!

Clinical Documentation Guide for Providers and Coders

This 42 page guide includes proper ICD-10 coding and clinical documentation for the most common diagnoses included in the risk models. A complete list of CMS-HCCs with RAF and demographics included. Order 1 for your entire team! Orders of 100 or more can be white labeled with your logo at no charge. Please email logo to kgifford@ermconsultinginc.com after purchase.

CMS-HCC Quick Coder

This 36 page guide contains a list of the most common HCC codes in the Medicare (CMS-HCC) model. Includes both medical (HCC) and pharmacy (RxHCC) codes. Orders of 100 or more can be white labeled with your logo at no charge. Please email logo to kgifford@ermconsultinginc.com after purchase. 

Visit our online store for a full list of available tools. https://erm.ecwid.com/

Advanced Risk Management and Office Based CDI Workshop

NEW DATES ADDED FOR 2017

* Workshops Consistently Rated 4.9 / 5.0 Stars By Attendees *

JOIN US FOR A DAY OF RISK ADJUSTMENT : 

    

§Review the different risk adjustment models and their impact on medical practice management.

§Discuss the impact of shifting from RAPS to EDS. What does this mean for office based claims?

§Take a deep dive into HCC Coding and Documentation. Review real examples to see what validates, what doesn’t, and why. Tips for engaging physicians.

§Learn how to leverage frontline staff to be successful in the world of risk adjustment and value based payments. 

APPROVED BY THE AAPC FOR 6 HOURS CEU

WHO SHOULD ATTEND?

•Medical Coders and Billers

•Providers / Medical Directors

•CDI Specialists

•Executive Leaders

•Compliance Professionals

•Health Alliance Members

•Rural Health Centers

•ACO, MSO and IPA Teams

•Medicare Advantage , Medicaid and Commercial Plans

EACH ATTENDEE WILL RECEIVE:

• Clinical Documentation and Coding Guide  $ 99 Value
• HCC Quick Coder (Mappings to ICD-10 Codes) for MA and Commercial Models
• Risk Adjustment Workbook and Appendix with Easy to Use Templates
• Laminated Coding and Documentation Tools 

WORKSHOP $399 –  EARLY BIRD $299 (Ends May 1st)

REGISTER TODAY - LIMITED SEATING AVAILABLE

July 21, 2017 - Orlando, FL

MELIÁ ORLANDO SUITE HOTEL AT CELEBRATION 

Download Complete Agenda - PDF

Register for the Orlando Workshop

Additional 2017 Workshops:

Boca Raton, Florida - September 12, 2017

Download Complete Agenda

Register for the Boca Raton Workshop


Ft Lauderdale, Florida - October 19, 2017

Download Complete Agenda

Register for the Ft Lauderdale Workshop






Visit www.ermconsultinginc.com to learn more

The Next Generation of Healthcare: Games and E-Learning – high value, low cost!

Games drive engagement through consumer activation. We know this! They are a fantastic way to challenge learners and keep them engaged and interacting with the content at hand.

So, how do we improve on something that is already awesome? We embed it in a learning ecosystem that drives improvement through partnerships with all stakeholders. This new learning environment sets the stage for providers, patients and caregivers to connect and communicate - anytime, anywhere, any place and on any device.

As we move towards a healthcare system that reimburses for value instead of volume we will need tools that can capture this next generation of care.  We will need to automate the processes of education and learning much like the electronic claims we send today. All of this data will then need to be interpreted to understand and truly visualize the path to wellness. That feedback will allow us to refine the process and continually work to improve the delivery of care.

But what if we can already do this through fun, engaging, and cost effective e-learning games? I believe we can! With the help of new technology, such as the xAPI, we can now track and measure all those things that were so hard to track before.

These short games below can capture up to 32 data points vs. the traditional check boxes, and take days to get to market instead of months. Imagine the possibilities. 

Click on a game below to launch.  Bird Hunt is a flash game, so you will need a flash browser. The Olympic Mountain Summit game is not. 

Fred was just diagnosed with type 2 diabetes and now he is afraid to enjoy the things he used to. This game combines his love of hunting with diabetes education. 

Johnny Three-Scoops and Earl Strong-Fit will not only be fighting for their individual victories tonight, but the fate of their entire teams may lie in the outcome of this single event. With only 3 events left, and this being the only event in which their respective teams have a real contender, this could decide the gold.

Can you help TEAM HEALTH reach the top first by correctly answering the questions?



For more fun, FREE Games visit our website: www.mhealthgames.com

Fighting Medicaid Fraud, Waste, and Abuse Through Education - Medicare Blog

By Ted Doolittle, CMS Deputy Director, Center for Program Integrity

Nov. 7, 2013 - The Centers for Medicare & Medicaid Services (CMS) wants everyone to join in the fight against fraud, waste, and abuse as part of our comprehensive strategy to protect federal health care programs and taxpayer dollars.  We are now making it easier than ever before for health care providers, managed care plans, and individuals and families with Medicaid benefits to use the education and training materials on the new Medicaid Program Integrity website.

Resources available on the website include videos, fact sheets, and checklists, made specifically for providers and beneficiaries.  These tools are national in scope, but some information can be personalized by your State of residence (or where you live) upon request. 

One of the key resources is a brochure on how people with Medicaid can protect themselves and the Medicaid program from fraud. You can also email MedicaidProviderEducation@cms.hhs.gov for the state contact number for reporting fraud.

State program integrity professionals and counselors will also find valuable education and training materials on the site – all available at no cost.  We have developed toolkits to address hot issues and frequently asked questions about Medicaid program integrity, including beneficiary protections and compliance resources for dental professionals and managed care organizations. 

Take a moment to learn more about the CMS Medicaid Program Integrity education and training materials available by clicking on this link, that will take you to the CMS.gov website.

Click here to join our listserv to receive timely notices of new material as it becomes available. Listserv members are also notified when new training, education, or speaking events are scheduled.

We value your feedback, recommendations, questions, and requests and encourage you to e-mail the Education Medicaid Integrity Contractor at medicaidprovidereducation@cms.hhs.gov for further information.

Thank you for being a partner in Medicaid program integrity!

And for more information on CMS’s efforts to protect consumers in the Health Insurance Marketplace, please visit:http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-09-18.html

MRA Education: 3 Strategic Aims for Medicare Advantage

EDPS

With EDPS, Coding and Encounter Reporting are the two critical components of risk adjustment that plans must address and master if they are to obtain the revenue they deserve and require to ensure their continued viability and success.

Small differences in encounter acceptance have a large impact on a plan’s revenue.

90% acceptance = $244  95% acceptance=$258   99% acceptance = $269  - A difference of $25MM

If that is not enough motivation, consider the 2013 OIG Work Plan

Encounter Data—CMS Oversight of Data Integrity (New) –

We will review the extent to which MA encounter data reflecting the items and services provided to MA plan enrollees are complete, consistent, and verified for accuracy by CMS. In 2012, MA encounter data reporting requirements will expand from an abbreviated set of primarily diagnosis data to a more comprehensive set of data. (One Time Notification, Pub. 100-20, CR 7562.) Prior CMS and OIG audits have indicated vulnerabilities in the accuracy of risk adjustment data reporting by MA organizations. (OEI; 00-00-00000; expected issue date: FY 2014, new start)

Accurate Funding

Complete and accurate medical records at the point of care provides better outcomes, improves the experience of care, reduces costs and adds value to all stake holders. How much money did you spend on chart reviews for “missed” diagnosis codes?  Consider the following example:

	RISK Score	Baseline Revenue	Potential Increase	Potential PMPM revenue 100% baseline
Present RAF	.8618	$676.92
Scenario 1	.90	$676.92	$53.59	$730.50
Scenario2	.95	$676.92	$94.17	$771.09
Scenario3	1.0	$676.92	$134.76	$811.67

Annual Attestation

MA Plans must certify that risk adjustment data is accurate, complete, and truthful (based on best knowledge, information and belief) (42 CFR 422.504 (I))

This creates a duty to, at a minimum, “put in place an information collection and reporting system reasonably designed to yield accurate information,” including ordinarily conducting “sample audits and spot checks…to verify whether the system is yielding accurate information

Kameron Gifford, CPC

www.ermconsultinginc.com

772-210-2823

kgifford@ermconsultinginc.com

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.

 

www.ermconsultinginc.com