Dr. Thomas McCarter, the Chief Medical Officer of TEAM of Care, is the leading physician expert witness in the country for consulting, medical expert reports, and testimony relating to medical necessity.
Coding for risk adjustment has become very risky for Medicare Advantage plans. CMS and the OIG have made it very clear that they are going to scrutinize HCC coding through additional audits and compliance regulations. These expose payers (and providers) to risk of increased denials, False Claims Act litigation, and extrapolation. So how can health plans and their coding vendors assure coding compliance without undue burden on the providers? A TEAM-Playbook that coordinates the TEAM-Work between the providers, health plan, and coding vendors. TEAM of Care inserts automated workflow steps that flag high priority codes, identify gaps, and assign follow-up tasks across all parties. The result is a closed-loop process that improves accuracy, improves compliance, and reduces the costs of audit activities.
Financial performance, quality measurement, and compliance in value-based care arrangements can significantly improve through tighter workflow coordination between payers and providers. TEAM of Care has improved risk adjustment performance, increased quality scores, reduced compliance risk, and reduced the cost of audits with our workflow coordination system.
Of course, your health plan has operational best-practices, policies, and procedures. When there are opportunities to improve operational performance, how do you isolate those for evaluation and redesign. What about compliance policies that need to change based on new regulatory guidance? When you make updates, how do you operationalize those changes? Is everything distributed to everyone all at one time? With a TEAM-Playbook, you can view your processes, make changes, and distribute them in a matter of minutes, hours, or days. TEAM-Work and TEAM-Management change immediately upon deployment.
