Reasons Why Diagnostic Coding Matters in Value-based Care

Margaret Maley, BSN, MS

Reasons Why Diagnostic Coding Matters in Value-based Care
AAOS Now – September 2018
by Margaret M. Maley, BSN, MS

Payers are great at collecting data. They use the information to develop payment policies, determine reimbursement rates, and, increasingly, to negotiate value-based contracts. Payers profit because they know how much it costs to take care of patients with certain illnesses and comorbidities. Payers know how to harness the power of data.

Orthopaedic surgeons—not so much.

Most orthopaedists fail to document and assign even the most basic data, such as comorbid conditions, that would support a higher cost of care in terms of time, visits, and complications. If you treat a highly complex patient base and aren’t diligently documenting such data, you will not fare well in a value-based payment world. As the Centers for Medicare & Medicaid Services (CMS) and commercial payers shift risk to providers in the form of bundled and value-based contracts, the importance of reporting diagnostic data has become paramount. The following are seven reasons why.

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