Category: Policy

Top 5 Questions Facing Risk Adjustment in 2017

Anita Joseph

From the looks of it, 2017 will be a big year for risk adjustment. There is a new administration in power in Washington, which will have far-reaching implications for the entire healthcare industry. And the risk adjustment space specifically will have to look inward, as it manages the currents of technological change and pries itself away […]

Conquering Commercial Risk Adjustment

Anita Joseph

Risk Adjustment an Important Business Factor for Commercial Exchange Plans In theory, the commercial risk adjustment program was intended to help insurers taking on the heaviest load from the commercial health exchanges. Health insurers would submit risk scores for each enrolled patient to HHS. HHS would calculate an average risk score for each plan and then mandate cash […]

3 Reasons to Care About Commercial Risk Adjustment

Anita Joseph

Participating in the commercial insurance exchanges isn’t easy. Plans have to develop a strategy for selling to individuals, set premiums, explain their network offerings to an entirely new consumer set, and orchestrate care for an unexpectedly sick population. Plus, they do all this in the face of intense public pressure and scrutiny. It’s no wonder […]

All About MACRA: Four Takeaways from CMS Chief Andy Slavitt’s Speech to the American Medical Association

Anita Joseph

On Monday, Centers for Medicare and Medicaid Services (CMS) Administrator Andy Slavitt addressed the American Medical Association’s 2016 annual meeting. Slavitt usually leverages such opportunities to send highly specific messages— at the JP Morgan Conference earlier this year, he told an audience of healthcare technology executives that interoperability had to be part of their mandate— […]

Building Physician Engagement Around CMS Risk Adjustment and Clinical Documentation

Anita Joseph

At RISE Nashville this week, we heard over and over that engaging physicians around clinical documentation is a struggle. These feelings echo what statistics have been saying for a long time: in a 2013 survey by the RAND Corporation, physicians described “time-consuming data entry” as a major source of professional dissatisfaction.  Strong CMS risk adjustment is […]

Ten ICD-10 Codes for Superheroes

Anita Joseph

It’s Friday, so let’s have some fun. Ever wonder how superheroes explain their on-the-job injuries to doctors? Well we tried to figure that out. After all, even superheroes have to file insurance claims. Scientist Bruce Banner is exposed to gamma radiation, turning him into the Hulk. W88.8: Exposure to other ionizing radiation. Teenager Peter Parker […]

Handling the Hype Around Interoperability

Anita Joseph

“We are deadly serious about interoperability,” said Centers for Medicare and Medicaid Services chief Andy Slavitt at the JP Morgan Healthcare Conference, “technology companies that look for ways to practice ‘data blocking’ in opposition to new regulations will find that it won’t be tolerated.” Epic, athenahealth, and other major players involved Slavitt’s blunt words have […]

Ten ICD-10 Codes That Influenced Harry Potter

Jamie Urborg

In honor of Alan Rickman’s passing, we thought it appropriate to celebrate his talented turn as Hogwarts Potions Master Severus Snape. Here are 10 ICD-10 diagnoses that influenced the magical world of Harry Potter. 1. In The Order of the Phoenix, Dudley Dursley punches Harry in the side of the head and small white lights pop in […]

So You Don’t Have Time to Read the CMS RADV Audit Proposal

Anita Joseph

Last week, CMS proposed expanding the risk adjustment audit program to cover all Medicare Advantage (MA) plans, every year. This is because they believe that mistakes in the diagnosis data that MA organizations submit to CMS lead to a drastic misallocation of resources–some plans are overpaid for their patients, and some are underpaid. CMS currently […]