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 →Charles Baker, VP, Compliance Solutions Compliance belongs at the strategic decision-making table to ensure the seamless integration of regulatory guidelines into the fabric of effective programs. For years, compliance in the health insurance sector, especially regarding government programs, has been synonymous with regulatory oversight. Compliance departments have
Read More →Baker is a distinguished leader in the healthcare industry, known for strategic expertise in health plan compliance and operational excellence ATTAC Consulting Group, a national leader in providing consulting, auditing, business operations and technology solutions to Medicare Advantage, Medicaid, commercial health insurers, and risk-bearing provider organizations, announced
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 →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 →Incomplete or inaccurate data from provider claims impacts risk scores Health plans are held accountable for the accuracy of data submitted to CMS. Often, plans act as data aggregators and submit data generated by providers and third-parties to CMS. Incomplete or inaccurate diagnosis data may lead to
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