• 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 […]

  • 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 […]

  • 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 […]

  • 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.

  • Health Fidelity offers conclusions on the flurry of CDC and CMS telehealth policy updates around coding and risk adjustment practices under COVID-19

  • In mid-December, the Health and Human Services Office of the Inspector General (HHS-OIG) announced that an investigation into Medicare Advantage organizations (MAO) had found $6.7 billion in potentially unsupported risk adjustment payments, generated from chart review programs that overwhelmingly yielded additional diagnoses. The study further found that 99% of chart reviews resulted in added diagnoses—not […]

  • Teresa Ross discusses the buzz around compliance in risk adjustment. Find out how technology-enabled solutions can help achieve the utmost compliance in an efficient and effective manner.