In late June, the Centers for Medicare & Medicaid Services released data demonstrating that its Risk Adjustment Program โ developed as part of the Affordable Care Act just five years…
The unavoidable shift toward value-based and two-sided risk payment models is here to stay โ and while the benefits are countless, the journey thus far has been slow and somewhat…
Population health and the transition to two-sided risk is no easy feat โ itโs a monumental shift in the way providers, payers and hospitals think about the delivery of health…
A recent study published by the Kaiser Family Foundation sheds light on a complex issue โ how to determine the real or predicted cost of care for Medicare Advantage plan…
Earlier this month, CMS announced changes to future payments for Medicare Advantage plans that will take effect in 2020. While a pay raise is part of the plan, what’s causing a stir is that payment will now be based on a higher percentage of patient encounter data (up to 25% from 10%). Many (especially payers) have argued that encounter data is often incomplete and inaccurate when compared to diagnoses, since encounter data relies on provider documentation.
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