Affordable Care Organizations (ACOs) are much in the news; but what is an ACO, and how can we measure its success?
Data strategies to identify target populations and launch targeted interventions
Claims Data Validation — the art and science of comparing diagnostic information from within the medical record to existing diagnoses received from providers on claims — is an essential part of any organization’s Risk Adjustment efforts.
CMS has officially started the transition from RAPS to EDPS
On April 4th, 2016, CMS released the Medicare Risk Adjustment Final Announcement and Call Letter for the Calendar Year 2017.
Tim Buxton, Director of Coding Services
There are a number of key elements, which both provider and coder should bear in mind when applying ICD-10-CM diagnostic codes to the field of Behavioral and Mental Disorders.
The General Equivalence Mappings (GEMs) cannot be relied upon for complete and accurate coding
The RADV Audit process in the HIX ("Commercial") sphere has several important differences from Medicare Advantage program
In early 2014, DHHS introduced the concepts of Risk Adjustment for the Health Insurance Exchanges (HIX)