Accurate RAF Scores Could Mean Billions in Savings for Medicare
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…
Encounter Data & Why Getting It Right is More Important Than Ever
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.
Medical Coding Risk Adjustment and Physiciansโ Pay by Nitin Thakor, President and CEO, GeBBS Healthcare Solutions
A recent article in Neurology Today covered the story of how a federal lawsuit is claiming that UnitedHealth Group (UHG), the nation's largest Medicare Advantage insurer, is inappropriately coding medical…
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