Category: Risk Adjustment

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Risk Adjustment

Your NLP Solution is Only As Good As The Data You Give It.

The success of Natural Language Processing (NLP) solutions for healthcare require more than just a solid AI program behind them. NLP solutions require extensive domain expertise on the part of the programmers and coders creating the solution alongside complex machine learning algorithms. Additionally, underneath every good NLP engine is a good set of training data – a dataset put together to show the machine the right way to make connections between entries.

Risk Adjustment

3 Data Points to Improve Medical Record Retrieval Rates

Medical record retrieval is vital for risk adjustment, HEDIS scores, and CMS Star ratings. Yet the process is time consuming, arduous, and costly, often resulting in physician abrasion and failure to retrieve charts.
Risk Adjustment

CMS to Release Medicare Advantage Encounter Data

CMS has collected data from Medicare Advantage plans since 2012 and began using it in 2016 to help calculate risk-adjustment payments, and it is now planning to make this data public. How can help plans leverage this data to improve their programs?
Risk Adjustment

Still struggling with Encounter Data Errors? Read this

The path to Encounter submissions is not an easy one. Learn what you can do to correct errors, better reconcile RAPS/EDPS, and allocate resources for a successful submission.
Risk Adjustment

Medicare HCC Prevalence by Specialty

Increase success rates of your programs. Discover which specialists are diagnosing which HCC codes with this interactive dashboard
Risk Adjustment

CMS Final Call Letter 2019

CMS Just Published the Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter
Risk Adjustment

Three Questions to Ask Before Signing a New Coding Vendor

When someone drops the ball, it’s time to find a new coding vendor — but how do you minimize risk? These are the three questions you should be asking your (potential) coding vendors.
Risk Adjustment

CMS Advanced Notice Part II

The CMS Advanced Notice Part II was released
Risk Adjustment

CMS Extends 2016 DOS Deadline for RAPS Submissions

A Three-Month Window Is Now Open to Ensure Your Health Plan Captures All HCC Value
Risk Adjustment

CMS 2019 Advance Notice

The 2019 Advance Notice will be published in two parts this year due to requirements in the 21st Century Cures Act
Risk Adjustment

Not All Coding Is Created Equal

The Nuances of HCC Coding — and the Necessity for Precision — Are More Important than Some Health Plans May Realize, Especially with Coming Changes Mandated by the 21st Century Cures Act
Risk Adjustment

Best Practices to Cure a Common Chart-Retrieval Ailment: Provider Noncompliance

When Providers Don’t Participate in Medical Record Retrieval, Retrieval Projects Suffer. But Strategies Exist to Mitigate the Ill Effects of Noncompliant Providers. Is Your Vendor Capable of Implementing Them?
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