MAOs face increasing risk of underpayment, negatively impacting both their bottom line and ability to provide optimal patient care.
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.
The 21st Century Cures Act Impact on Medicare Advantage Risk Adjustment: Part IV – Using Multiple Years of Diagnosis Data
A key provision of the CCA would significantly expand the relevant timespan for medical record reviews, offering both opportunities and challenges.
Recent Court Ruling Reinstates the Overpayment Rule
The recent reinstatement of the overpayment rule has significant implications for Medicare Advantage plans.
The 21st Century Cures Act Impact on Medicare Advantage Risk Adjustment: Part III – Adjustments for Dual Enrollees
The 21st Century Cures Act also makes substantive changes to the way dual enrollees are accounted for in the MA risk adjustment models.
The 21st Century Cures Act Impact on Medicare Advantage Risk Adjustment: Part II – Adjusting for Additional Conditions
The 21st Century Cures Act includes newly-designated conditions for mental health disorders, substance abuse disorders, and chronic kidney disease.
The 21st Century Cures Act Impact on Medicare Advantage Risk Adjustment: Part I – Adjusting for the Number of Conditions Each Enrollee Has
In addition to the impact on health IT interoperability, the 21st Century Cures Act (CCA) has profound Medicare reimbursement policy implications.
Potential COVID-19 Impacts on Medicare Managed Care Risk Adjustment
The COVID-10 pandemic has upended the health care industry, creating new challenges in the world of risk adjustment.
How Real AI Can Revolutionize Risk Adjustment
Artificial intelligence and innovation have become synonymous in the healthcare industry.
Risk Adjustment Validation Under Medicare Advantage: Part II
The sampling methodology employed for the risk adjustment data validation process has a significant impact on the payment recovery process.