The 2024 Notice of Benefit and Payment Parameters recently released by HHS proposes several changes with significant implications for risk adjustment within the ACA marketplace.
The Importance of Supplemental Diagnosis Code Submissions for ACA Risk Adjustment
The submission of supplemental diagnosis codes can have a significant impact on payment within the Affordable Care Act Risk Adjustment program.
Section 508: Are You Compliant?
The rapid advancement of health care IT has led to renewed focus on the accessibility standards which apply to federal agencies and the companies with which they do business.
Improper Payments in Federal Healthcare Programs
Federal legislation requires oversight and corrective action with regards to improper payments, creating significant burdens for plans participating in government healthcare programs.
OIG Audits
Certain medical conditions identified by OIG as “high-risk” serve as particular points of vulnerability for MAOs facing an audit.
Risk Adjustment in ACA Marketplaces: The 2023 Final Rule
HHS has published the final 2023 Notice of Benefit and Payment Parameters, implementing significant changes to the risk adjustment program for qualified health plans.
Risk Adjustment in ACA Marketplaces: What to Watch Out For in Benefit Years 2023 and Beyond
Changes in the proposed rule for the ACA marketplace with regards to risk adjustment in future benefit years portend critical impacts to participating health plans.
The Medicare Advantage Payment Cycle: Opportunities & Obligations
Understanding the full Medicare Advantage payment cycle is critical to navigating the risk adjustment process, maintaining compliance, and maximizing the financial viability of MA health plans.
Including Social Determinants of Health factors in the Medicare Advantage Risk Adjustment Program
CMS is considering ways to enhance to its Medicare Advantage payment model to accommodate for the impacts of social determinants of health.
MA Risk Adjustment to Complete Shift to Encounter Data in 2022
The impending shift to encounter data being the sole source of diagnosis information for risk adjustment presents significant challenges to MA plans in 2022 and beyond.