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Third Pass: Risk Adjustment QA and Compliance
Compliance is an integral part of any risk adjustment strategy. The goal of capturing HCC codes is to accurately capture the full health status and disease burden of both individuals (and therefore populations) under value-based care. In this sense, the financial incentive is ultimately another tool CMS uses to motivate participants in risk-sharing arrangements towards […]
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Technology Partnerships and Health Fidelity: Close Only Counts in Horseshoes
In data-driven tasks, using structured data is an excellent first step that can get people very close to the goal. Unfortunately, too many organizations rely on it past its early usefulness. Structured data in healthcare is effectively a codified derivative of what’s “real.” It’s an approximation based on a few narrow parameters that are input […]
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Risk Adjustment Compliance Recap: Best Practices for Avoiding Legal Action
Last week, Health Fidelity hosted a risk adjustment legal compliance webinar, “Risk Adjustment Compliance: Best Practices for Avoiding Legal Action.” I had the privilege of being joined by Health Fidelity VP of business development John Blevins as well as lawyers and healthcare legal experts Stephen Bittinger and John Lawrence of K&L Gates. The event itself […]
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Prioritizing Risk Capture Compliance with NLP
In the past few weeks, several new stories have broken around risk capture compliance issues, particularly when it comes to Medicare Advantage. Individual DOJ lawsuits around MA risk capture and government agencies like the OIG weighing in on MA policy itself have led to a barnstorm of op-eds. The crux of these stories, even the […]
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A 3% Annual RAF Improvement isn’t Nearly Enough.
Depending on the individual risk sharing arrangement, CMS will cap annual risk score improvement to a 3% RAF lift over the benchmark for a population. This can lead to a very common assumption, that 3% can be used as an obvious, un-nuanced goal for risk adjustment strategy each year. Unfortunately, this is incorrect. Fortunately, we’re […]
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Risk Adjustment and Revenue Cycle: Benefits and Steps to Success
Risk adjustment and revenue cycle are becoming increasingly intertwined as more providers take on larger risk contracts under value-based care, shifting the mix away from traditional fee-for-service. Historically, risk adjustment has been dominated by retrospective reviews for the purposes of supplemental submissions. However, the same cashflow pressures that drive focus on revenue cycle performance are […]
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What is HCC Coding in Risk Adjustment?
Despite the pivotal role value-based care has in healthcare in the United States, it’s often not well understood. In the same spirit in which we covered the basics of risk adjustment and two-sided risk, today we want to tackle HCC coding in risk adjustment. With any luck, you’ll come away with a better understanding of […]
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Building a Top Workplace Culture in the Bay Area and Beyond
Recently, Health Fidelity was named a Top Workplace by the Bay Area Newsgroup. The list is compiled by a third-party research group who analyzes employee opinions about all areas of company culture that make a workplace appealing and rewarding. First, I want to say how invigorating this is for us. We’ve put a lot of […]
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Value-Based Care and Health Equity Post 2021
After more than a decade of debate, litigation, and experimentation, the adoption of value-based care and alternative payment models endures, and 2021 is presenting us with a picture of what more can be done with value-based care and health equity. First, beyond the headlines and political posturing, policymakers and market players have persevered through ongoing […]
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Concurrent EDPS and RAPS support from Lumanent
Health Fidelity is pleased to share that the Lumanent platform is fully prepared to offer concurrent EDPS and RAPS support, congruent with the CMS-HCC risk adjustment model transition.
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Health Fidelity Company Culture: The Hackathon
There’s no shortage of focus on innovation in technology. It’s a big part of Health Fidelity’s company culture. Google and Atlassian tout the 20% rule, that people should have 20% of their time each week to dedicate to fully creative projects. Not every organization is scaled to dedicate that much time away from the primary tasks, but […]
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What is two-sided healthcare risk?
Depending on your role at a health plan or risk bearing health system, you’re aware of value-based care (VBC) models. However, depending on the model itself (and sometimes within the same model of value-based care), there can be different variations of two-sided healthcare risk, also known as upside and downside. An organization’s level of engagement […]
