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. …
Concurrent Review for Risk Adjustment – Why “Cleaning As You Go” Works in Healthcare, Too
Posted in Payer SolutionsIf you’ve ever worked in a restaurant or commercial kitchen – you know one of the golden rules is to “Clean as You Go.” Employing a “Clean As You Go” policy is lauded not only for its efficiency, but also for its ability to reduce the risk of problems associated with health, safety and hygiene …
Value-Based Care – It Starts and Ends With Documentation
Posted in Value-Based CareWe’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 …
NLP Healthcare – Risk Adjustment Meets Artificial Intelligence
Posted in Healthcare Technology, Payer SolutionsBig data is all the rage – transforming industries from tech to retail and much more. Healthcare – an industry slow to adopt technology in many ways now has access to more data than ever before with the widespread adoption of electronic health records (EHRs). But, what do we do with all this data in …
It’s Working – CMS Report Concludes the Effectiveness of Risk Adjustment
Posted in Healthcare Technology, Payer SolutionsIn 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 …
The #1 Most Critical Driver in the Successful Adoption of Shared Risk Programs
Posted in Healthcare Technology, Payer SolutionsThe 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 …