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MA Deadline Extensions for 21-22: CMS Policy Update and Strategy Guidance
Earlier this year, we discussed the final call letter from CMS detailing the Medicare Advantage (MA) deadline extensions for PY 2020 (i.e. 2019 dates of service) to account for COVID-19 related disruptions. We suspected, but had no confirmation at the time, that this would continue going forward. While CMS hasn’t made any public announcements, we […]
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CMS Policy Update: RAPS and EDPS, Model Updates, and PY 2022 Risk Calculations
Last month, CMS released their final announcement for calendar year (CY) 2022. This is a follow up to the advanced notice we covered September, particularly around the RAPS and EDPS transition. Before we begin, I think it’s important to mention that while not every facet of every update from CMS impacts every organization the same […]
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CMS Submission Deadline Extension Clarification
On 9/18/20, CMS announced a submission deadline extension option for 2019 dates of service (DoS) for Medicare Advantage organizations, PACE organizations, Medicare-Medicaid plans, and other cost contractors from 2/1/21 to 8/2/21. The announcement created some confusion, namely that the 2/1/21 deadline still existed alongside the 8/2/21 final deadline. There wasn’t clear direction on why nor […]
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CMS Policy Update on Encounter Data and Positive Risk Score Impact
On September 14th, CMS released part I of an advanced notice on risk adjustment for Medicare Advantage. The advanced notice itself has caused a stir despite being an update on the already in-progress transition toward the exclusive use of EDPS (encounter data processing system) for risk adjustment data submission, and the phasing out of RAPS […]
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An effective and essential risk adjustment strategy includes the prioritization of chronic condition recapture each year. The benefit of prioritizing your HCC recapture rate comes directly from the requirement of re-confirming a diagnosis and treating it. First, it ensures regular contact with clinicians to monitor and manage chronic conditions, overall improving the quality of care. […]
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Medical Loss Ratio and COVID-19: Investment, Risk, and Looking through 2022
For payors, Medical Loss Ratio is down to a point of short-term crisis and long-term complication this year and next. However, there is a solution: payer investment in pre-encounter programs that drive quality and care.
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The Overlooked ROI: Redaction, Chart-Linking, and CMS Penalty Avoidance
Using a workflow enabled by technology that enables, and actively supports, both additions and redaction (deletion), isn’t just easy and cost effective, it has value beyond its intrinsic ROI. Chris Gluhak explains the importance of eliminating inaccurate codes while looking for potential additions to avoid CMS penalties in audits.
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Six Emergent Best Practices in Telehealth Risk Adjustment Coding
Telemedicine is accelerating, in both adoption and refinement; review the emerging best practices for actionable insights to ensure effective submission and mitigate audit risk.
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Risk Adjustment and Telehealth Policy under COVID-19
Health Fidelity offers conclusions on the flurry of CDC and CMS telehealth policy updates around coding and risk adjustment practices under COVID-19
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Illuminating Natural Language Processing in Healthcare
Natural language processing (NLP) has become a buzzword in healthcare. Organizations across the industry have moved into the space, and, for the most part, we support these moves. As an organization, we believe in the value of using artificial intelligence to support human experts in boosting the administrative stability and quality of care. Healthcare is, […]
