Blog

Stay up to date with all things Episource
Quality

Announcement of Calendar Year (CY) 2020 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter

On April 1, 2019 CMS released the 2020 Medicare Advantage (MA) and Part D Rate Announcement and Final Call Letter. In this document there were substantive changes that will impact the 2020 and 2021 Star Rating programs.

Risk Adjustment

How to Close Care Gaps For 2019

When it comes to creating a care gap closure program, there’s no one-size-fits-all approach. A wide range of strategies and tactics can help, but by looking at your data, using predictive analytics, and creating personalized campaigns, it is possible to close care gaps before 2020.

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.

Load More

GET STARTED TODAY

We simplify the management of member programs by making it radically more efficient, and increasing value to healthcare organizations and their members
EXPERIENCE IT