Plan should start to take steps now to determine the impact of the blend and model change in the 2021 Advance Notice to their risk scores and revenue, and mitigate potential adverse impacts of the risk adjustment changes.
Tag: risk adjustment
OIG Cracks Down on Chart Reviews in Medicare Advantage Risk Adjustment
The Office of Inspector General (OIG) report on the use of chart reviews in Medicare Advantage risk adjustment raises a number of concerns for Medicare Advantage Organizations (MAOs). How can plans mitigate risk from chart review submissions and stay compliant with CMS risk adjustment guidelines to ensure complete and accurate reimbursement?
Compliant Coding and Documentation: Minimize Compliance Risk with CMS through HCC audit programs
Was your plan selected for this year’s Medicare Part C Contract-Level Risk Adjustment Data Validation…
Open Enrollment and Risk Adjustment
As for many who are in the depths of risk adjustment, you may be just…
Trump Halts Risk Adjustment Payments, Impacts Health Plans & Consumers
As if the complexities around healthcare affordability couldn’t get more convoluted, the latest news from…
Spotlight on Risk Adjustment in 2019 Final Call Letter for Medicare Advantage & Part D
The Centers for Medicare & Medicaid Services (CMS) released the Final Call Letter on April…
Advance Notice Update – Risk Adjustment
Now that Part II of the Advanced Notice and Call Letter has been released, we…
CMS Withholds Critical Medicare Advantage Analysis; Why?
Controversy is brewing in the healthcare insurance community since the much anticipated Medicare Advantage (MA)…
Preserving Your Investment Through the Member Experience
I was on a client call last week with a few of our Gorman Health…
Evolution Through Strategy: Pinpointing Growth Opportunities
My last article explained the choice of Medicare Advantage (MA) health plans to evolve or…