By Stephanie St. Thomas – Poor patient (or member) matching plagues every single component of healthcare, often in different ways and with varying degrees of visibility into the problem.
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By Tom Peterson – Risk adjustment enables CMS to pay health plans based on the anticipated cost of covering care for the beneficiaries they enroll. Therefore, it’s important for health plans (and provider groups with percent of premium contracts) to get risk adjustment right.
By Tom Peterson – Several months ago, CMS released the Final 2018 Call Letter, which describes exactly what rules, regulations, and reimbursement Medicare Advantage Organizations will experience in the coming year.
By Deborah Grider – Coding in a Value-Based World: Is your revenue at risk? If your hospital or practice isn’t fully adhering to the risk adjustment and Hierarchical Condition Category coding requirements for Medicare Advantage plans, the answer may be yes.