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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 ...

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...

crunching the numbers as ACA risk adjustment transfer payments are put on hold

On Monday, the Centers for Medicare & Medicaid Services (CMS) released the health plan-specific 2017 benefit year risk a...

video: suspecting analytics transformed—the rapid movement from clinical rules to machine ...

In the complex world of risk adjustment, health plans rely on suspect analytics to identify members with possibly undocu...

podcast: sifting the 2019 Medicare Advantage Final Rate Notice

The Centers for Medicare & Medicaid Services (CMS) has just released its final 2019 Medicare Advantage and Part D Rate A...

improve your pitch with retrospective chart review financial analytics

Now that spring is officially here, your thoughts might be turning to America’s favorite pastime: baseball. Successful p...

breaking it down: proposed Medicare Advantage risk adjustment model changes for 2019

The Centers for Medicare & Medicaid Services (CMS) has released its advance notice of proposed changes to the Medicare A...

how to navigate RAPS-to-EDS revenue expectations

In the 2017 payment year, the 25 percent Encounter Data System (EDS) contribution and its impact on risk scores and asso...

trick or treat: solving the spooky RAPS/EDS transition challenge

Visiting a corn maze on Halloween can be fun, but trying to navigate the transition from RAPS to EDS has been more like ...

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