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
The Centers for Medicare & Medicaid Services (CMS) released its 2015 Payment Transfer Report on June 30, 2016. Now that plans have had a chance to digest their results, we asked our in-house experts for insight on what plans should be considering as they prepare to begin submissions for benefit year 2016.
As its beneficiary population continues to expand, the Medicare program faces persistent pressure to do more with less. With The Centers for Medicare & Medicaid Services (CMS) facing continual legislative and regulatory payment policies, along with significant program cuts, budgets are sure to further tighten across the program, potentially impacting benefits for individuals enrolled in Medicare Advantage (MA) programs.... Read More
This week, the U.S. Department of Health and Human Services (HHS) announced the Affordable Care Act’s (ACA) transitional reinsurance payments and permanent risk adjustment transfers for the 2015 benefit year. Per the Centers for Medicare & Medicaid Services (CMS), the permanent risk adjustment program is designed to “minimize the negative effects of adverse selection and help level the playing field between insurance companies, thereby fostering a stable, vibrant market in which issuers are rewarded for providing high-quality, affordable coverage, not for offering plans designed to attract the healthy and avoid the sick.”... 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
With the implementation of its payment transfer model, The U.S. Department of Health & Human Services (HHS), in conjunction with the Centers for Medicare & Medicaid Services (CMS), has defined how health plans should expect to conduct business when participating on the Health Insurance Marketplace. This payment transfer model has the potential to significantly impact a plan’s revenue as it transfers funds from plans with lower-risk enrollees to those with higher-risk enrollees.... Read More
2016 is expected to present new risk adjustment reporting challenges for Medicare Advantage plans. We recently visited with our internal analytics expert, Suzanna-Grace Sayre, to learn more about how CMS policy changes may affect plans going into the New Year and beyond.
While the U.S. healthcare system is known for its rapid access to specialty providers and patient-centered care, the country continues to struggle with managing healthcare costs, expanding access, and improving efficiency. The United States is consistently ranked the most expensive healthcare system in the world, spending over 17 percent of its GPD on healthcare compared to an average of 10 percent among other developed countries. Healthcare expenditures are continuing their upward trend and the forecast looks bleak as the population ages into Medicare eligibility and premiums and cost-sharing continue to rise. As one method to bend the cost-curve and improve patient health the idea of value-based insurance design (VBID) is gaining traction.... Read More
While the Medicare Advantage risk adjustment model has been in place for several years now, health plans are just beginning to fully understand the model and its impact on payment for certain subsets of the Medicare population, especially those that are dually eligible for Medicare and Medicaid. Dual-eligible beneficiaries have many demographic and health-related characteristics that differentiate them from other populations, as well as influence how they are scored under the risk adjustment model.... Read More