The success of any healthcare organization hinges on its ability to consolidate resources, share knowledge among teams, and promote collaboration. In one example of collaboration for the greater good, let’s explore the crucial role of case management in risk adjustment. Here are six ways your plan can
Read More →The metrics related to the average number of retrieved charts and coded charts per unit of time (day, week or month) are crucial for effective project planning and successful completion of any retrospective chart review program. By monitoring these metrics, managed care organizations can gauge the efficiency
Read More →The Department of Health and Human Services, Office of Inspector General (OIG) continues to actively audit Medicare Advantage Risk Adjustment programs, with a focus on diagnosis codes at “high risk of being miscoded.” Between Feb. 2021 and May 2023, OIG issued 25 audit reports that uncovered significant
Read More →A high-performing risk adjustment member engagement program is crucial for healthcare organizations to accurately assess and document the health status of members. Here are four steps for health plans to take now that will enhance risk score accuracy, improve care coordination and achieve better outcomes. Clearly Identify
Read More →As we count down to the third quarter, it’s time for plans to review year-to-date progress against 2023 risk adjustment roadmaps and determine if any course corrections are needed. Here are four proactive steps health plans should take now to avoid the frenzied fourth-quarter push: Evaluate completion
Read More →Since 2021, the OIG has issued 24 audit reports, and four of the reports have been published so far in 2023. These audits identified more than $400 million in overpayments, with approximately 72% of audited HCCs not validated / supported within the medical documentation The Office of
Read More →In-home care plays an important role within the US healthcare system. When done correctly, an in-home assessment provides a comprehensive overview of a patient’s health status, which is vital to identify potential health risks and can help ensure optimal outcomes for members who are unable to receive
Read More →The Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit is a vital process conducted by CMS to ensure the correctness of payments to MA plans. CMS determines monthly payments based on the health and demographic characteristics of each member, as determined by the Hierarchical Condition Category
Read More →It’s time for plans to transition from a waiting period to a move-forward moment After five years of waiting, Medicare Advantage plans now know CMS’s position on CMS and OIG audit extrapolations. It’s time for plans to transition from a waiting period to a move-forward moment, and to
Read More →CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the
Read More →
