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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Revenue Cycle Management- An Interdisciplinary Approach

Posted in Revenue Cycle Management (RCM)

In healthcare, providers at the bedside know the care team goes far beyond the nurse and doctor. Delivering the highest quality care requires an interdisciplinary model where experts are called on as needed, information is shared, collaboration and continuous performance improvement are part of the process. Much like a patient’s care team, there are many …

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Rev Up Your Revenue Cycle with AI

Posted in Health Information Management (HIM), Healthcare Technology

With profit margins shrinking and the cost of health care going nowhere but up, operational leaders and consultants throughout the healthcare industry are looking in every nook and cranny to either find ways to cut costs or generate more revenue. With the ongoing need for costly equipment, an expert workforce and the state-of-the-art facilities needed …

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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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Strategies for Mastering Two-Sided Risk

Posted in Payer Solutions

Population health and the transition to two-sided risk is no easy feat – it’s a monumental shift in the way providers, payers and hospitals think about the delivery of health care. And, while, we all know it’s coming – knowing how to get there and doing it successfully is the real challenge. While most accountable …

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