The Voice of Jessica Smith

Jessica Smith

About Jessica Smith

Jessica Smith is Vice President of Healthcare Analytics & Risk Adjustment Solutions at Gorman Health Group (GHG). In this role, she is responsible for the execution and oversight of risk adjustment consulting services for managed care, provider practice, and commercial market clients, and leading and integrating cross-functional teams to ensure superior performance outcomes related to risk adjustment operations. Read more

Risk Adjustment Importance During Open Enrollment

Jessica Smith

Now is the time of year when everyone is preparing for back-to-school events and the upcoming holidays, but in that mix is the ever-so-important…Medicare Open Enrollment. Medicare Open Enrollment is an important time to keep or lose valuable members who may have been long-time participants or new to the plan in the last year. There are many reasons member retention is important, but one that is not often talked about it risk adjustment. Risk adjustment has many different types of models utilized to calculate a member’s risk score. The more consistent information you have about a member, the more accurate risk score can be calculated and will allow for an easier understanding of member gaps in care.

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CMS Withholds Critical Medicare Advantage Analysis; Why?

Jessica Smith

Controversy is brewing in the healthcare insurance community since the much anticipated Medicare Advantage (MA) analysis due to be released at the AcademyHealth annual research meeting was cancelled. Today, MA plans enroll more Medicare-eligible beneficiaries than Fee-for-Service (FFS). The desire to understand the needs and services these beneficiaries have and are receiving is great.

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Guidance on the 2016 HHS-Operated Risk Adjustment Data Validation Program

Jessica Smith

Last week, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 Health and Human Services Operated Risk Adjustment Data Validation (HHS-RADV) would be conducted as a pilot year in the same aspect as the 2015 HHS-RADV. This announcement came two days after the final risk adjustment data submissions were due to be submitted to the EDGE server for 2016 dates of service.

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The Transition from RAPS to EDPS

Jessica Smith

The comments have rolled in, and the concerns regarding the transition from Risk Adjustment Processing System (RAPS) to Encounter Data Processing System (EDPS) have been heard. The final Medicare Advantage Call Letter was released on April 3, 2017, and it contained a surprise on every page that was turned.

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The New World of Data Submissions: Know Your Data

Jessica Smith

Even though the year has just begun, the healthcare industry is looking ahead to what the next four years has in store. The Centers for Medicare & Medicaid Services (CMS) released its 2018 Medicare Advantage and Part D Advance Notice and Draft Call Letter (“2018 Draft Call Letter”) on February 1, 2017. As a whole, the 2018 Draft Call Letter had minimal updates, however, there were important impacts to risk adjustment.

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Healthcare Analytics – The New Age of Technology Innovation

Jessica Smith

It’s no surprise healthcare analytics is a hot topic in the insurance industry today. New and enhanced Centers for Medicare & Medicaid Services (CMS) regulations that govern healthcare have become more aligned with technical solutions, moving health plans to adopt more cutting-edge analytics to drive decisions. With the passing of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physicians and physician groups will start to move more towards aligned analytics as well. The need to look at microanalysis increases each day, so in a day and age driven by data and technology, what’s next for healthcare analytics?

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Data Integrity: The Foundational Approach to Risk Adjustment

Jessica Smith

Risk adjustment has been around for many years now, but the terms “data governance,” “data integrity,” and “data definitions” were not mainstream until recently. Why is that?

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