The Centers for Medicare and Medicaid Services (CMS) requires all Medicare Advantage (MA) plans to implement effective compliance programs that prevent, detect and correct non-compliance with CMS program requirements, to exercise reasonable diligence in identifying overpayments, and to report and return such overpayments to the Medicare Program within 60 days.
Are You Prepared if Your Organization Is Selected for the Payment Year (PY) 2014 Risk Adjustment Data Validation Audit?
The Last “R” Standing: Is Risk Adjustment Causing Your Organization to Question Your Long Term Ability to Succeed in ACA?
The Three Rs
If you are involved in health plan risk adjustment, you probably know that three premium stabilization programs were included in the Affordable Care Act (the “Three Rs”: Reinsurance, Risk Corridors and Risk Adjustment). With the expiration of reinsurance and risk corridors in 2017, risk adjustment remains the only mechanism to mitigate the impact of risk selection and promote market stability. Are you ready?
Whether you’re supplementing your own internally-run health risk assessment program or searching for a vendor with assessment solutions that meet all of your needs, finding and choosing the right partner can be a daunting task. Once you have a vendor in place, what is the best way to ensure that you’re getting the most out of your relationship?
Medication Therapy Management (MTM) services provide education, improve medication adherence and detect adverse drug events and can also help identify and address member concerns and empower them to self-manage their medications and health conditions. Since the Centers for Medicare and Medicaid Services (CMS) added the MTM Program Completion Rate for Comprehensive Medication Review (CMR) measure with a weight of 1 to Star Ratings in 2016, it now also has a direct impact on plan revenue. The average 2017 rating for this measure was 2.8 for PDP plans and 2.4 for MAPD plans—but like all Star Rating measures, this is a moving target. With the CY 2018 May program deadline around the corner, it’s time to explore the challenges associated with this measure, plus how you will reach and engage eligible members to improve completion rates.
This month you are likely finishing up your supplemental data source (SDS) collection and source code submission in order to meet the May deadlines. But have you considered the possible sources of valuable information that may already be available in your organization? Before you deploy that team of nurses to scour medical records and perform medical record reviews (MRRs), check with your risk team for home assessment medical record documentation derived from a prospective annual health assessment. CenseoHealth assessments meet the requirements for a compliant medical record and can close several HEDIS measures including:
It’s a new year. That means new data sets, budgets and opportunities for closing gaps in care and improving Star Rating scores and risk scores. With all of 2017 laid out in front of everyone, there’s a chance to move the needle and positively impact the members and patients of each healthcare delivery organization.
As 2016 comes to a close, we'd like to take this opportunity to thank our readers who regularly keep up with our blog, and welcome you if you're a new reader!
Adults age 65 and older are at higher risk for contracting contagious illnesses and diseases such as the flu, and can have a more difficult time rebounding. That’s why it’s especially important to communicate to health plan members ways they can stay happy and healthy during the busy holiday season.
Since only 49 percent of Medicare Advantage Part D active and rated plans in 2017 received 4 Stars or better for their 2017 overall rating, many are seeking ways to improve Part C and Part D measures that impact these scores.
In the summer of 2015, Janet Wood CPC, CRC, and Kat Mulligan CPC, CRC, saw the need for starting a local chapter of the American Academy of Professional Coders, an organization that provides certifications, training and continuing education for medical coders.
But even with access to several local chapters in Dallas and Fort Worth, the commute times to meetings became too much of a hassle.