Description:

This webinar from ARCHPRO Coding provides a three-part overview of the evolving landscape of Quality Reportingspecifically tailored for RHCs and FQHCs. This session dives into the critical "why" behind the efforts required for meeting our quality reporting contractual agreements with, typically, managed care patients. We explore the transition from traditional fee-for-service models to Value-Based Care, where the focus shifts toward disease prevention and clinical outcomes. By understanding the rationale and workflows for reporting usually non-revenue generating data, your team can move from viewing these tasks as "extra work" to seeing them as essential components of a proactive, data-driven patient care strategy.

For ACO members, ICD-10-CM coding is the key to unlocking Shared Savings by accurately reflecting patient complexity and staying under cost benchmarks. This overview is designed to build awareness of how payers utilize this data and how your facility can maintain compliance and clinical integrity without being overwhelmed by deep-dive technicalities.

The session breaks down the technical intersection of CPT-II performance measures, ICD-10-CM, and Hierarchical Condition Categories (HCCs). We discuss how capturing complete diagnostic data—even when it doesn't directly impact a claim's reimbursement—is vital for accurate Risk Adjustment Factors (RAF).

Session Highlights:

• The Rationale of Quality: Understanding why state and federal payers require supplemental data to predict outcomes and manage complex patient populations.
• Workflow Optimization: Strategies for integrating CPT Category II codes and HEDIS measures into existing clinical routines without creating undue burden.
• Risk Adjustment Mastery: How to utilize ICD-10-CM and HCCs to ensure your patient's medical complexity is fully recognized, impacting everything from care management eligibility to ACO shared savings.
• Payer Alignment: Navigating mandatory and voluntary submissions for various stakeholders while maintaining a positive, professional relationship with all third-party payers.