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the 2019 Star Ratings program: making the cut

The Centers for Medicare & Medicaid Services (CMS) last week published its 2019 Part C and Part D Medicare Star Ratings ...

podcast: how clinical validation is good for payers, providers, and patients

When a health plan denies a claim, the provider wants to know why it was denied. Sometimes, the answer is that a modifie...

how consumers, employers, and the government are coming “off the sidelines” in value-based...

While collaboration between payers and providers is the most crucial component of delivering better care at lower cost i...

the three fundamentals of risk adjustment success

The term “risk adjustment” means different things to different people depending on their role. The Centers for Medicare ...

payer-provider collaboration tools: a state of the union

The imperative for payers and providers to collaborate in a systematic way has never been stronger. But while technologi...

the twin engines of clinical validation

Advanced analytics applied by an automated claim editing system are crucial for identifying claims that are potentially ...

reflections from a healthcare IT “up-and-comer”

Wednesday, Becker’s Hospital Review recognized Verscend’s Jordan Bazinsky, executive vice president of product and strat...

busted: rounding up the top fraud schemes of Q2 2018

The nation’s top special investigators and law enforcement officials were hard at work stamping out the weeds of healthc...

breaking it down: CMS reinstates ACA risk adjustment payments

On Tuesday, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that enables the federal government t...

podcast: how risk adjustment coding validation gives health plans more certainty

Compliance is becoming an increasingly difficult challenge for Medicare Advantage plans, especially when it comes to the...

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