The countdown to the HEDIS® 2017 reporting deadline is well underway. Are you on track? Our Verscend experts are here to share their insights on effectively managing your measurement and reporting process in our monthly blog series, “from the HEDIS 2017 trenches.” Here, client manager Leah Breeggemann offers insight on optimizing your chart chasing efforts.... Read More
Health plan executives across the country have a lot of planning to do now that the 2018 Advance Payment Notice for Medicare Advantage (MA) and Part D plans has been released by the Centers for Medicare & Medicaid Services (CMS). The agency is now accepting public comments on the notice through March 3, 2017, before publishing the final version on April 3. We sat down with Verscend’s Sean Creighton, senior vice president of risk adjustment, to get a quick roundup of the key highlights.... Read More
There’s no question that automated claim editing is a crucial component of accurate and efficient claims payment. Using black-and-white sourced edits from the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association’s (AMA) CPT® book, as well as payer-sourced custom rules, these systems save plans a significant amount of money by keeping them from paying incorrect claims without human intervention.
But is having one automated claim editing system enough to ensure total claim accuracy, or are you leaving significant savings on the table without a secondary editor? And if you already have a secondary editor, is there a benefit to adding a tertiary editor? Here are three fast facts you should know about how far automated claims editors can go.... Read More
Verscend this week received the 2017 Best in KLAS award for payer quality analytics and reporting solutions. This first-of-its-kind award pitted top solutions against each other, using KLAS Research’s well-established methodologies and exhaustive customer research to evaluate vendor and solution performance across multiple categories. Verscend scored an 84.7 out of 100 in the ranking, published today in the report, “2017 Best in KLAS: Software & Services.”... Read More
Unfortunately, it is all too easy to find a news story about the devastating impact of opioid abuse as the epidemic continues to spiral out of control and ravage lives across the country. From babies born to opioid-addicted mothers—and children ignored while parents overdose—to the music superstar Prince dying suddenly from an accidental fentanyl overdose, the plethora of stories that have surfaced in recent years is truly tragic. According to the CDC, more than 183,000 people died in the United States from 1999 to 2015 from overdoses related to prescription opioids, with the number of victims quadrupling over that same period.... Read More
The countdown to the HEDIS® 2017 reporting deadline has begun. Are you on track? Our Verscend experts are here to share their insights on effectively managing your measurement and reporting process in our new monthly blog series, “from the HEDIS 2017 trenches.” Here, Ashley McNairy, product director for Verscend’s Quality Improvement solutions, gets us started on the right foot.... Read More
Whether your provider organization is just getting started on its population health journey or looking for a change from its current solution, there are many potholes to avoid along this challenging road—along with several side trips that could easily become a distraction from your ultimate goal. Check out our infographic below to help you steer in the right direction when it comes to choosing the tools you’ll need.
$13,500. That is the average cost victims pay to resolve medical identity theft—when they can resolve it.
Medical identity theft occurrences are becoming more common. Incidents increased 22 percent from 2014 to 2015, impacting more than 2.3 million people in the United States, per the Ponemon Institute’s Fifth Annual Study on Medical Identity Theft.... Read More
You have many choices to make when it comes to how your health plan will conduct Medicare Risk Adjustment (MRA). Among the most critical choices is how you’ll retrieve your medical records for retrospective review and coding. How can you find the right partner to work with in order to ensure a successful MRA season? We recently sat down with our own medical record retrieval guru, Howard Gross, to help guide health plans in their decision-making process for pursuing medical record retrieval.... Read More
Our final healthcare news roundup of 2016 looks at the current state of Republican plans to repeal the Affordable Care Act (ACA), potential challenges to implementing the Medicare Access and CHIP Reauthorization Act (MACRA), a new initiative aimed at integrating behavioral health services with primary care, and an increase in healthcare spending on children.... Read More