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Risk Adjustment

Coronavirus Updates

As the pandemic continues to affect risk adjustment programs, Episource helps you keep track of the government’s policy response. Updated regularly.

News Roundup

A Summary of the Recommendations for Re-Opening Hospitals and Healthcare Systems During COVID-19

Our summary of CMS and White House guidelines for re-opening non-emergent, non-COVID-19 care, including recommended considerations and requirements of a phased approach.

In-Home Health Assessments

Transitioning From Telehealth Back To In-Home Assessments

Our plan for to safely transition back to in-home assessments. We outline the safety precautions and methods we’ll employ to adhere to government guidelines.

News Roundup

Reflecting on RISE National 2020

The RISE organization hosted its first virtual conference, RISE National. While in-person engagement was certainly missed, the value and quality of presentations and discussion did not disappoint.


Taking Control of Your ACO Population with Telehealth

COVID-19 has made it necessary for ACOs to find new ways to navigate risk and deliver patient care—and telehealth has emerged as a powerful tool to help them do just that. Learn more about the challenges ACOs are facing, the regulatory measures CMS is taking to address them, and the four primary use cases in which ACOs can leverage telehealth.

Risk Adjustment

DIY or Vendor: Should You Partner for Risk Adjustment Services?

With the recent changes to the existing risk adjustment model and the higher percentage of encounter data that will make up risk scores, health plans are now focused more than ever before on ensuring they’re prepared to secure the same RAF. To assist in your preparations, our Vice President of Client Services gives you the insight on the top priorities you should consider before making important vendor decisions.

Risk Adjustment

ONC & CMS Final Rulings Grant Patients Unprecedented Control of Health Data

On March 9, senior healthcare officials announced the release of two of the most extensive rulings ever passed around the way electronic health information is exchanged: the CMS Interoperability and Patient Access Final Rule and the ONC Cures Act Final Rule. The separate but interrelated rulings represent a huge step forward for interoperability and increased patient access, giving members unprecedented control over their health data.

Risk Adjustment

COVID-19 Coding Operations Update

As COVID-19 has shut down the in-person operations of businesses across the globe, the pressure is on for risk adjustment vendors to remain stable and shift their coding operations to a work-from-home setting. While many vendors are not set up in such a way to easily make this transition, Episource has been able to quickly and seamlessly migrate our global teams to work from home with no impact to quality or deliverables.

Risk Adjustment

CMS Releases Telehealth Ruling Regarding Applicability of Services for Risk Adjustment

In response to the incredible burden placed on American healthcare institutions by the novel coronavirus outbreak, the Centers for Medicare & Medicaid Services have announced their decision to allow diagnoses captured during telehealth visits to be risk adjustable.

Risk Adjustment

COVID-19 Brings Telehealth to the Forefront

In a bid to contain the novel coronavirus (COVID-19), President Trump declared a national emergency on March 13, unlocking $50 billion in aid and expanding Medicare telehealth benefits. Aimed at providing Medicare beneficiaries greater access to healthcare services, the move will help members receive safe, continual care while limiting exposure and spread of the virus.

Risk Adjustment

ONC, CMS Interoperability Rules: A Review

Recently, the Office of the National Coordinator for Health Information Technology (ONC) released a draft of their Strategic IT Health Proposal for 2020-2025. This proposal addresses the deliverables included in the 21st Century Cures Act, which focuses on making health data accessible to patients and care providers, increasing choice, encouraging competition, and fostering innovation.

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