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
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
Health plans across the country expend significant energy on annual HEDIS® quality reporting requirements. With quality metrics increasingly tied to financial success, the importance of both a successful submission process and continued performance improvement has only grown.... Read More
This week’s healthcare news highlights efforts by the Centers for Medicare & Medicaid Services (CMS) to balance the field among Affordable Care Act (ACA) exchange markets, updates on ICD-10 requirement flexibility, and the latest pushback from providers on the Medicare Access and CHIP Reauthorization Act (MACRA).
In its Summer 2016 newsletter, the Resource Initiative and Society for Education (RISE) features an interview with Verscend experts on the hot topic of the Centers for Medicare & Medicaid Services’ (CMS’) shift in how the risk adjustment factor scores for Medicare Advantage (MA) will be determined going forward. The interview sheds light on the implications of the transition from the Risk Adjustment Processing System (RAPS) to the Encounter Data System (EDS).... Read More
There is one healthcare acronym that is currently impacting provider organizations across the country more than any other—MACRA. While MACRA, or the Medicare Access & CHIP Reauthorization Act of 2015 is not a new subject, a notice by the Centers for Medicare & Medicaid Services (CMS) in late April has elevated the urgency for providers to know and understand the proposed legislation and its repercussions.... Read More
From methodology updates to a new way to segment eligible populations, 2017 offers up some impactful rule changes that could potentially affect Medicare Advantage plans. In today’s blog, we’ve outlined CMS’ 2017 Medicare Advantage final rule changes and how you can best prepare in advance:
In early April, the Centers for Medicare & Medicaid Services (CMS) released its Final Call Letter outlining payment methodology changes to the 2017 Medicare risk adjustment model. To understand how the final changes could financially impact Medicare Advantage plans, we discussed the changes with Verscend’s director of risk adjustment analytics, Suzanna-Grace Sayre, and asked her to offer suggested success factors that plans can employ for the 2017 reporting season.... Read More
Provider organizations have almost too many options when it comes to finding population health management expertise and system support, including analytics, data aggregation, clinical workflow/care management, and patient engagement. With the market expected to reach $4.2 billion by 2018, it’s not surprising that new vendors pop up practically daily, or that existing vendors are beefing up their solution portfolios to capitalize on the opportunity. As providers’ wish lists continue to grow—driven in part by government initiatives and commercial payers’ programs—system selection starts to take on the overwhelming feel of a second EMR implementation. This is causing providers to hesitate just when they need to act.... Read More
Following the release of the Centers for Medicare & Medicaid Services’ (CMS’) proposed changes for 2017 Medicare Advantage (MA) growth rates and adjustments to the HCC risk adjustment model, the industry is abuzz with questions and thoughts on what to prepare for. With less than a month until the final 2017 Rate Announcement and Call Letter, we have highlighted three proposed changes to the risk adjustment model and methodology that will likely impact plan revenue.