From DRG Accuracy to RAF Optimization: Mastering CDI for Payer Profitability
11th December 2024 | 11am PST
Speakers
Accurate coding is the lifeblood of health plan profitability. Improper coding can lead to missed revenue opportunities, inaccurate DRG assignment, and financial penalties. This webinar explores how Clinical Data Integration (CDI) empowers you to achieve optimal coding accuracy and maximize your bottom line.
Health Chain dives deep into the power of CDI for unlocking hidden financial benefits, including:
- Unearthing Missed Revenue & DRG Accuracy: Identify under-coded diagnoses and procedures. Leverage CDI to pinpoint these missed opportunities and ensure accurate DRG assignment, leading to higher reimbursement from Medicare and Medicaid. A 2021 study by AAPC found that effective CDI programs can identify up to 10% of missed coding opportunities, translating to millions in additional revenue for large health plans [1]. This translates to improved DRG accuracy, a critical factor for appropriate reimbursement.
- Optimizing Risk Adjustment: Capture all relevant factors impacting patient health complexity. CDI programs enable comprehensive data, ensuring accurate risk adjustment through optimized RAF scores. This translates to higher revenue under risk-based payment models.
- Minimizing Reimbursement Risk: Ensure complete and accurate data to minimize the risk of improper coding and potential recoupments. CDI empowers you to comply with current coding guidelines, reducing the threat of financial penalties from regulatory audits.
Takeaways:
- Learn how a well-designed CDI program can significantly improve the accuracy of DRG coding and RAF calculations, leading to increased revenue potential.
- Discover how optimized risk adjustment through effective CDI translates to a significant financial advantage for your health plan.
- Gain insights into how improved data practices, facilitated by CDI, can ensure coding compliance and minimize the risk of financial penalties.
- Get a free copy of Gartner’s report on “How Clinical Data Integration Improves U.S. Healthcare Payer Interoperability”
Explore Upcoming Webinars
Closing the Care Gap: Leveraging CDI for Member Population Disparity Identification and Mitigation
Healthcare disparities plague the industry, leading to worse health outcomes for specific member groups. Traditional administrative claims ...
From Cost Centers to Revenue Drivers: How CDI Can Improve Health Plan Performance
Clinical Data Integration (CDI) programs are often viewed as a budgetary burden, requiring dedicated staff and ongoing ...
From Data Overload to Actionable Intelligence: Lowering Barriers to CDI Implementation
Healthcare organizations are swamped with an ever-growing sea of data, making it challenging to extract actionable intelligence for ...
Minutes from Past Webinars
The Ultimate Checklist for Health Plans to Close Care Gaps
Understand how Medicare Health Plans are closing care gaps in Member experience by ingesting FHIR data, monitoring HEDIS quality measures and streamlining Payer workflows.
RADV Final Rule: Focus on PCP-RA Team Collaboration
Health Chain breaks down the RADV compliance and talks about how Medicare Health Plan Risk Adjustment teams can improve HCC coding by collaborating with Primary Care Physicians.
Unlocking Point-of-Care Insights: ADT Messages Decoded
Health Chain team delved into use cases for Medicare Health Plan care management teams, showcasing the transformative impact of ADT messages in enhancing Member care.
