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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 ...

improve medical record retrieval success by analyzing provider behavior patterns

Medical record retrieval is labor intensive, consumes time and resources, and requires great patience and persistence—bu...

infographic: analyzing 2017’s risk adjustment valuation to improve 2018’s processes

How is your health plan setting its target return on investment (ROI) per chart for your 2018 retrospective risk adjustm...

amid healthcare reform, ACA risk stabilization goes on

While the House and Senate attempt to re-write healthcare policy, the pressing problems that the Affordable Care Act (AC...

step up your game: how to improve risk adjustment coding accuracy

The Office of Inspector General (OIG) sets the bar for coding accuracy at 95 percent, but you can’t achieve that goal wi...

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