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 submission of supplemental diagnosis codes can have a significant impact on payment within the Affordable Care Act Risk Adjustment program.
Federal legislation requires oversight and corrective action with regards to improper payments, creating significant burdens for plans participating in government healthcare programs.
Maximizing the benefits of outsourcing while minimizing the risks to quality requires a delicate balancing act on the part of healthcare organizations.
Recent technological innovations have emerged which facilitate the often painful yet necessary process of chart chasing.
Certain medical conditions identified by OIG as “high-risk” serve as particular points of vulnerability for MAOs facing an audit.
HHS has published the final 2023 Notice of Benefit and Payment Parameters, implementing significant changes to the risk adjustment program for qualified health plans.
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.
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.
CMS is considering ways to enhance to its Medicare Advantage payment model to accommodate for the impacts of social determinants of health.