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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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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 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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Managing Medicaid risk adjustment is almost never a top priority. State by state regulations differ, making it complicated and costly to perform, and it is not often financially worth the trouble. Medicaid risk adjustment is effectively budget neutral, in that the funding is a fixed pool, apportioning dollars between organizations covering those lives based on […]
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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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Accelerating Recovery in Reimbursement for Value-based Care Post COVID-19
Implementing a post-encounter coding review is an effective way to ensure complete and accurate capture of all 2020 risk adjustable conditions - without burdening clinical teams - while informing care and stabilizing revenue. Finding and closing these gaps today, with fee-for-service revenues having bottomed out and many provider organizations in a precarious financial position, is especially critical.
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The Future of Value-Based Care Post COVID-19
Robin Lloyd, HF Chief Commercial Officer, envisions the longer-term impact on healthcare delivery, policy, and technology following the coronavirus pandemic.
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The Opportunities of Technology-Enabled Risk-Sharing
Over 10% of the U.S. population is now covered by an accountable care organization (ACO), and the number of risk-adjusted lives is growing at roughly 15% to 20% each year. To date, risk adjustment has primarily consisted of payers retrospectively reconciling work done with payments owed. What impact will tech-enabled risk sharing have on these […]
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Coders Code: The Imperative Reduction of Non-Clinical Work for Physicians
Healthcare is a technological paradox. On the clinical side, the bleeding edge of science and engineering present physicians with increasingly greater imaging tools, robotic surgical devices, gene-targeted therapy: the limits of what is technologically possible in healthcare are in lockstep with the limits of human understanding. At the same time, despite two decades of explosive […]
