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Medicare Advantage Updates

Medicare Advantage Enrollment Update – March 2019

Learn about the top organizations, biggest enrollment changes, and year-over-year growth

Medicare Advantage Updates

Medicare Advantage Enrollment Update – February 2019

Learn about the top organizations, biggest enrollment changes, and year-over-year growth

Risk Adjustment

4 Steps to Increasing Risk Adjustment Coding Accuracy

Accurate risk adjustment coding is essential for generating accurate risk scores and the quality of patient care. Here are four steps to make your risk adjustment coding more accurate.

Risk Adjustment

V23: How To Ensure Retrospective HCC Code Capture

When the new CMS-HCC Risk-Adjustment Model (V23) took effect in January 2019, it included 4 new HCC categories, 83 new HCC codes and more than 9,500 ICD-10 codes. Capturing the codes will be a challenge since they require special expertise on the part of the provider. When it comes to retrospective HCC code capture, it’s vital that plans have the right data and processes to ensure accurate reimbursement. Here are some strategies to consider.

Medicare Advantage Updates

Medicare Advantage Enrollment Update – January 2019

Learn about the top organizations, biggest enrollment changes, and year-over-year growth

Risk Adjustment

How many HCCs does it take?

The time has come for the PCC/APC models to start being implemented, changing the way populations and their scores shape up. With the PCC model now including the additive risk scores for the condition count, CMS has decreased many of the individual HCC risk scores used in the current model—for instance diabetes will see a 14% decrease, with reductions counterbalanced by an increase in other risk scores. The change led us to do a statistical analysis that assessed the impact of these substantial changes.

Quality

V23: 3 Ways To Capture HCCs during HRAs

In January 2019, when the new CMS-HCC Risk-Adjustment Model (V23) takes effect, it will include 4 additional HCC categories, 83 new HCC codes, and more than 9,500 ICD-10 codes. Learn how to overcome the challenges health plans will face with these changes.

Risk Adjustment

Advance Notice 2020 Part 1

The recently released CMS Advance Notice 2020 Part 1 may not have many surprises in it, but there are a number of key components that will have far-reaching consequences for health plans. The April 2, 2018 final ruling foreshadowed many of the new changes by confirming that CMS will, in fact, have to implement the 21st Century Cures Act. That means that changes from reviewing and assessing the risk adjustment model will begin in 2019 with full effectuation in 2022 and beyond. In the immediate future, health plans will have to deal with some consequences that range from the good to the not-too-bad to the ugly.

Medicare Advantage Updates

Medicare Advantage Enrollment Update – November 2018

Learn about the top organizations, biggest enrollment changes, and year-over-year growth

Infographic

2018 ACA Enrollment by the Numbers Infographic

The Affordable Care Act (ACA) hits its eighth year in 2018. The program, designed to provide affordable health insurance to more American citizens, saw a decrease in enrollment from 2017. Let's dive into the numbers behind ACA enrollment in 2018.

Medicare Advantage Updates

Medicare Advantage Enrollment Update – September 2018

Learn about the top organizations, biggest enrollment changes, and year-over-year growth

Infographic

How Are Your STARS Ratings Measuring Up?

View an interactive infographic of plan performance for each of the different STARS measures.

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