A proposed update to the RADV appeals process would have significant ramifications for Medicare Advantage Organizations.
Proposed Changes to MA RADV Appeals Process
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Viewing Category: Risk Adjustment
Multi-year Trends in Supplemental Diagnosis Codes
We examine patterns amongst data across multiple years in this final installment of our supplemental diagnosis code blog series.
HCC Failure Rate Groups and the Supplemental Diagnosis File
In this follow-up blog on supplemental diagnosis codes, we take a deep dive into failure rates, how they are calculated, and the impact they have on the risk adjustment data validation process.
Medical Coding – The Importance of Following Authoritative Guidelines and References
It is essential that healthcare organizations utilize industry-recognized best practices and guidelines when establishing a medical coding process.
Accurate Medical Coding, Part 3: Evaluating Medical Coding Reliability with IRR
In this third and final part of our medical coding blog series, we look at inter-rater reliability as a metric for determining coder reliability, along with the strengths and pitfalls of utilizing it.
Accurate Medical Coding, Part 2: Understanding Sources of Variation in Medical Coding
Accurate medical coding is critical to all healthcare stakeholders, but a range of factors can lead to variation and errors, with negative impacts to financial and patient health outcomes.
Accurate Medical Coding, Part 1: The Role of Medical Coding in Healthcare Payments
Accurate medical record coding is at the heart of billing and reimbursement, and common coding mistakes can have significant financial consequences.
RaLytics Comments on the 2024 ACA Proposed Rule
In response to the notice of benefit and payment parameters for ACA published by HHS, RaLytics has a number of suggestions on how to ensure the ACA risk adjustment process is more efficient and equitable for everyone.
RADV Final Rule
CMS has published its final rule for Medicare Advantage risk adjustment data validation, codifying a number of changes with far-reaching ramifications for MAOs.
The 2018 MA RADV Proposed Rule
In anticipation of CMS publishing its final Medicare Advantage risk adjustment data validation rule, there are a number of key issues from the agency’s earlier proposed rule from 2018 to keep an eye on.