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Topic: Risk Adjustment
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.
The Gorman Health Group 2017 Forum concluded last week in New Orleans with over 200 of our closest clients and partners. As we enter our 21st year, we returned to where it all began for us, with a little startup called Peoples Health, our first and closest client who now dominates southern Louisiana. The Forum ended the day JazzFest 2017 began, so many of us stayed to enjoy the festival and the best of New Orleans heritage and culture.
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.
Yesterday the Trump Administration released the final notice of payment policy for Medicare Advantage for 2018, and it was better than expected. It’s a rare ray of sunshine for health plans and their members since Trump took office with a vow to repeal ObamaCare, and confirms that Medicare Advantage (MA) is the only safe game in all of health insurance these days.
Risk adjustment has seen its share of action this year, with a sudden spotlight of alleged fraudulent risk scores by many insurers in Medicare Advantage (MA). Last Friday, we saw the latest escalation of these actions, with the Department of Justice (DOJ) filing yet another notice to intervene, this time in a California case brought about by whistleblower James Swoben in 2009.
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.