Medicare Advantage Risk Adjustment

CMS released yesterday the Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter. The following highlights the biggest changes from the February, 29, 2016 Advance Notice that impact Medicare Advantage (MA)...
As the nation transitions to ICD-10 coding on October 1, 2015, health plans and physicians continue to express concerns that it will take time to adapt to the new version of codes. ICD-10 codes, which provide greater specificity to better represent and communicate a patient’s clinical conditions, in...
For years health plans have struggled to develop successful strategies to ensure their government payments are aligned with the health of their members. To achieve success, it is critical that each member's diagnoses are accurately documented. What better way to get this documentation than from a me...

Getting the Bosses' Buy In: The Definitive Prep Kit

Posted on: Oct 22, 2013 | Authored By: Alanna Stage, Editor
As you are number-crunching, do you see a solution to an internal pain point of your business? 2014 can be the year you implement change, whatever is in your mind's eye: bringing more business to your health plan, starting a charitable initiative, installing a cost-saving measure, or on-boarding a ...

Q&A: Upcoding

Posted on: Feb 27, 2013 | Authored By: Dr. Mark Dambro, Chief Medical Officer
We recently received this question from a health plan regarding upcoding, see what Chief Medical Officer Dr. Dambro, had to say in response.
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