Acronyms
What does EMR stand for?
EMR ( Electronical Medical Record)
What is Value-Based Healthcare?
Value-based health care is a framework for restructuring health care systems with the overarching goal of value for patients, with value defined as health outcomes per unit of costs
In short: We care about the patient overall health vs How fast we see them.
What is the Operations Specialist role at Main Street?
Operations Specialist: We cross-reference data from the EMR or PM with the CCA. This data must match for accuracy.
What is a CCA? What purpose does it solve?
CCA ( Comprehensive Care Assessment)
This is used to evaluate the patients medical cost needs. Accurate Dx coding will let the government know what to pay for medical costs.
What does PM stand for ?
PM ( Practice Management )
What areas do we serve and why?
Rural areas are Main Street's focus point.
Rural areas have limited care for patients and most times care is out of reach.
What is a CPT?
What is an Health Navigator?
A health Navigator is someone stationed in a clinic(s) to ensure the health of our patients. They meet with patients on a regular to discuss needs regarding their health.
What does VPN stand for?
VPN ( Virtual Private Network)
What is risk adjustment care?
Risk Adjustment- a statistical method that seeks to predict a person's likely use and costs of health care services. It's used in Medicare Advantage to adjust the capitated payments the federal government makes to cover expected medical costs of enrollees.
What is an ICD-10 Code?
International Classification of Diseases, Tenth Revision (ICD-10) is a system used by physicians to classify and code all diagnoses, symptoms and procedures for claims processing.
What type of insurance must you have to see a Navigator?
Medicare Advantage or Medicare A / B
What does RDP stand for?
RDP ( Remote Desktop)
What area of Tennessee did Main Street start?
West Tennessee
How does ICD-10 codes correlate with value-based healthcare?
The correlation comes with the overall health of the patient. There are levels to the coding for ICD-10 that determines how ill a patient is. We want results of overall health and in order to do so the coding must be specific to the patients need to deliver on our mission.
Who funds the risk adjustment model?
CMS( Centers of Medicare and Medicare Services) fund the risk adjustment model.
What does CCA stand for?
CCA ( Comprehensive Care Assessment)
How many Clinics does Main street partner with?
900+ clinics nationwide.
What is the purpose of the Operations Specialist validating that diagnosis codes were billed?
This will tell Medicare how much is needing to be payed to cover the medical expense of a patient. Coding must be done accurately to ensure all funds are received.
Why is it important for the ICD-10 codes to be processed by payers?
CMS will pay the payers based on how sick a patient is and Main Street partners with the payers to take over the patient's care coordination. which is how Main Street gets paid.