CenseoHealth would like to congratulate the 170 Medicare Advantage contracts with prescription drug coverage (MA-PDs) that earned 4 stars or higher for their 2018 overall Star Rating. This means that 73 percent of MA-PD enrollees will be in plans rated with 4 stars or higher in 2018, compared to roughly 69 percent this year, according to the Centers for Medicare & Medicaid Services (CMS).
At the end of June, CMS issued the proposed rule for the 2018 performance year of the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization (MACRA) Act.
As a reminder; the Merit-Based Incentive Payment System (MIPS) is one of the two Quality Payment Program (QPP) value-based payment programs. The second is the Advanced Alternative Payment Model (AAPM). The first performance measurement year for the MIPS is 2017, with the payment year being 2019. For 2017, MIPS will be based on performance in three categories:
- Advancing Clinical Information (n/a for hospital-based providers in 2017)
- Clinical Practice Improvement Activities
There have been many media reports over the past few months concerning impending changes to the health care system as a result of significant legislation currently under consideration by Congress. While legislative efforts to repeal and replace the Affordable Care Act (ACA, or “Obamacare”) is currently stalled, President Trump continues to demand that Republicans take action to fulfill the promises they have made to the public for the last seven years.
Are You Prepared if Your Organization Is Selected for the Payment Year (PY) 2014 Risk Adjustment Data Validation Audit?
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.
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!