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RISE to the occasion: quality, risk adjustment, payers, and providers converge

Posted by Sean Creighton and David Bartley on 3/21/17 10:56 AM

Although its Nashville location remains the same, the Annual RISE Summit continues to grow in size and importance each year. RISE, or the Resource Initiative and Society for Education, has been bringing its membership together for 11 years to address fundamental issues in risk adjustment, performance measurement and improvement, and payment integrity. The American Health Care Act, the GOP alternative to the Affordable Care Act, was a focal point for this year’s meeting with its release on the eve of the conference. However, RISE is well known for its best-practice sessions, and while the future continues to be debated, there is clearly plenty of work still getting done to move the industry closer to value-based healthcare delivery and payment even in the midst of uncertainty.

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the art and science of handling Medicare risk adjustment coding “gray areas”

Posted by Deb Bradley on 3/9/17 8:30 AM

While the Centers for Medicare & Medicaid Services (CMS) has guidelines in place for Medicare risk adjustment coding, that doesn’t mean that every Medicare Advantage plan will code the same way. In fact, there is room for many different approaches—and it’s up to each plan to decide what will lead to the best outcome. We caught up with Deb Bradley, Verscend’s senior vice president of clinical coding services, to talk about how health plans can seek a better return on investment in their Medicare risk adjustment programs.

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how to support successful MRA through medical record retrieval

Posted by Howard Gross on 1/4/17 9:01 AM

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.

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planning ahead: tactics for success in commercial risk adjustment

Posted by Allison Dessert on 8/17/16 2:10 PM

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.

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10 steps to enhance your medicare risk adjustment success

Posted by Verscend on 7/20/16 9:45 AM

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.

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first look at HHS' 2015 benefit year risk adjustment transfers

Posted by Sean Creighton on 6/30/16 8:59 PM

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.”

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how CMS’ medicare advantage final rules could impact your plan

Posted by Verscend on 5/18/16 10:46 AM

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:

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the financial impact of 2017 medicare advantage payment rules

Posted by Suzanna-Grace Sayre on 5/12/16 6:10 AM

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.

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8 tips for a seamless commercial risk adjustment program

Posted by Verscend on 5/4/16 9:20 AM

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.

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prepping for what’s next in risk adjustment

Posted by Suzanna-Grace Sayre on 1/6/16 2:13 PM

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. 

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