Category: Risk Adjustment

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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.

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.

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.

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

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