Industry Blog
Recent Blog Entries
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.
Payment Inaccuracy in the Medicare Advantage Program: Underpayment Due to Underreported Diagnoses
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.
Federal Appellate Court Reinstates Medicare Advantage Overpayment Rule
The US Court of Appeals for the District of Columbia Circuit has issued a landmark ruling which has important implications for risk adjustment payments in the Medicare Advantage program.
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.