Charles Baker, VP, Compliance Solutions Congress may be stuck in partisan stalemates, but risk adjustment reform is one area where the gears are still turning. The No UPCODE Act (S.1105), introduced this spring, has quickly become the focal point for Medicare Advantage payment debates. What’s in the Bill? Chart reviews
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In the HEALTHCARE STARcast, host Subbu Ramalingam breaks down the complex world of healthcare to reveal the real strategies and mindsets driving excellence. In this episode, Subbu Ramalingam talks with Charles Baker, Vice President of Compliance Solutions at ATTAC Consulting Group. Charles has worn many hats in
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Subbu Ramalingam, Managing Director, ATTAC Consulting Group As we enter the second half of 2025, health plans and provider organizations are approaching a critical strategic inflection point. With the final push to close out 2026 health plan products, HEDIS® seasons and CAHPS® surveys—and the ongoing need for
Read More →In the first few weeks of Donald Trump’s second presidency, Medicare Advantage plans faced a tremendous amount of uncertainty as the White House threatened to pause federal financial assistance activities, issued multiple executive orders outlining the new administration’s priorities, and targeted diversity, equity and inclusion (DEI) initiatives
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
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The Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit is a vital process conducted by the Centers for Medicare and Medicaid Services (CMS) to ensure the correctness of payments to MA plans. CMS determines monthly payments based on the health and demographic characteristics of each member,
Read More →Medicare Advantage organizations may not have gotten the outcome they were hoping for in CMS’s recently finalized Risk Adjustment Data Validation rule, but industry experts say they weren’t surprised by the position CMS ultimately took after years of pressure to close out RADV audits and recover identified
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