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The Pulse: Risk Adjustment Insights from an Industry Expert

The Pulse: Risk Adjustment Insights from an Industry Expert

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Welcome to AAPC’s new podcast, The Pulse. Hosted by expert, Lori Cox, MBA, CPC, CPMA, CPC-I, CEMC, CGSC, CHONC, each episode will feature interviews with healthcare leaders to discuss industry updates and uncover relevant, actionable advice to help you improve your revenue and eliminate risks.

Risk Adjustment (RA) is a complicated and fast-growing area in the business of healthcare. In Episode One, Lori Cox sits down with Dr. Khush Singh, a well-known risk care management consultant, to talk about lawsuits related to RA, increased activity from OIG and the Department of Justice, and to answer questions like:  

  • Due to these risk adjustment lawsuits, what changes do you see coming in the next few years? 

  • What role do coders play in the quality of care? 

  • Do you think we will be able to pull diagnosis from other types of documentation?  

  • What advice do you have for providers participating in managed Medicare plans?  

Plus, they discuss ACA and Medicare Advantage Risk Adjustment programs, CMS demanding payback, and more.  

About the author

Lori Cox

MBA, CPC, CPMA, CPC-I, CEMC, CGSC, CHONC, Regional Director, AAPC Services / Director of Client Engagement, AAPC Services / AAPC /

Lori Cox has over 25 years of experience working in the business side of healthcare. She began her career in patient accounts and then moved into billing and coding for a multispecialty clinic. She was eventually promoted to billing supervisor and then to compliance officer, where she wrote, maintained, and trained employees and providers on fraud and abuse. Currently, Cox works for AAPC Services as Director of Client Engagement, performing audits and education for clients across the U.S. She has spoken at HEALTHCON and regional conferences and has traveled the country educating coders and physicians on complex coding topics such as hem/onc and E/M guidelines. Cox is the past member relations officer for AAPC’s National Advisory Board.

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