Industry Blog
Recent Blog Entries
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.
Risk Adjustment in ACA Marketplaces: What to Watch out for in Benefit Years 2024 and Beyond
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.
Quality Assurance of Outsourced Medical Record Reviews
Maximizing the benefits of outsourcing while minimizing the risks to quality requires a delicate balancing act on the part of healthcare organizations.
How Analytics Can Help with Chart Chasing
Recent technological innovations have emerged which facilitate the often painful yet necessary process of chart chasing.
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.