Are You RADV Audit Ready? Three Strategies to Get You There

Posted in Payer Solutions

The Centers for Medicare and Medicaid Services (CMS) recently announced plans to ramp up its risk adjustment data validation (RADV) audit program in 2020 based on a recent study by the Office of Inspector General (OIG), which found potential issues related to Medicare Advantage Organizations (MAOs) using chart reviews to inappropriately increase risk adjusted payments. …

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Value-Based Care – It Starts and Ends With Documentation

Posted in Value-Based Care

We’ve all heard the adage – when it comes to healthcare, if it wasn’t documented, it wasn’t done. This couldn’t be more true when it comes to value-based care – particularly as it relates to the Centers for Medicare & Medicaid Services risk adjustment program. This innovative program offers higher payments to providers who deliver …

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It’s Working – CMS Report Concludes the Effectiveness of Risk Adjustment

Posted in Healthcare Technology, Payer Solutions

In late June, the Centers for Medicare & Medicaid Services released data demonstrating that its Risk Adjustment Program – developed as part of the Affordable Care Act just five years ago – is working just as planned. What was the plan? To prevent payers from developing plans intended to attract healthier patients and to incentivize …

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The #1 Most Critical Driver in the Successful Adoption of Shared Risk Programs

Posted in Healthcare Technology, Payer Solutions

The unavoidable shift toward value-based and two-sided risk payment models is here to stay – and while the benefits are countless, the journey thus far has been slow and somewhat painful for payers, providers and healthcare organizations alike. Healthcare is one of the slowest industries to effectively adopt technology and the reasons for this are …

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