We help health plans and risk-bearing providers improve outcomes across their risk adjustment and quality programs.
Health plans are facing a storm of changes with the arrival of the V28 risk adjustment model for Medicare Advantage, along with increased scrutiny from the OIG and CMS. With audits on the rise and regulations constantly shifting, plans need different strategies and approaches to ensure their risk adjustment and quality programs are compliant. We… Continue reading Navigating V28 and the Changing Regulatory Landscape: 3 Strategies for Health Plans
On April 1, The Centers for Medicare & Medicaid Services (CMS) released the Medicare Advantage (MA) PY2025 Final Notice. Here are some of the highlights for risk adjustment and quality programs: Risk Adjustment Model Updates Most commentators supported the continued rollout of the V28 risk model. The main improvements to the V28 risk model are the… Continue reading CMS PY2025 Final Notice: A Summary
Medicare Advantage (MA) organizations are under extreme scrutiny to ensure proper coding to reduce overpayments for MA beneficiaries. The recent toolkit released by the Office of Inspector General (OIG) identifies the commonly miscoded diagnosis codes that result in inaccurate risk adjustment scores and lead to overpayments. OIG found that over 70% of the codes were… Continue reading Risk Adjustment Coding Challenges: Reducing MA Audit Risk
Effective member engagement allows a health plan to accurately assess the health status of its members. Engaged members are more likely to participate in their healthcare, seek information about providers, and adhere to treatment plans—all of which lead to better health outcomes and lower costs. Members who take an active role in their health and… Continue reading Three Strategies to Improve Member Engagement
On January 30th, CMS released its Final Rule regarding the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. You might be wondering how these new RADV rules will impact your MAO. Here are a few points to consider. 1. Many conditions in the Medicare Advantage population continue to be inappropriately coded 2. CMS has… Continue reading The RADV Final Rule: What You Need to Know
“Not everything that can be counted counts, and not everything that counts can be counted” – Albert Einstein. We could not agree with this more, especially when it comes to managing your membership and the risk score of that population. The definition of risk adjustment and its stated purpose is as simple as a process… Continue reading Optimizing Your Risk Adjustment Program: Top KPIs to Measure Success
Providers hold the key to successful medical record retrieval. This means that developing positive relationships and limiting abrasion must be a priority and a core competency for every record retrieval vendor.
For quality improvement initiatives, prospective monthly runs can give you better insight and help you stay on top of results.
Change can be stressful, especially when it comes to HEDIS®. With several updates anticipated in the coming months and years, you need to be prepared. Advantmed’s HEDIS experts have been monitoring the National Committee for Quality Assurance (NCQA) and the market overall. Based on our research, we have summarized several important changes anticipated for 2020 and… Continue reading HEDIS® 2020: What You Need to Know Now
At Advantmed, we focus on helping health plans optimize risk and improve quality. Part of that preparation involves making sure you’re ready for a possible RADV audit. Michelle Zilisch, Advantmed’s Director of Client Solutions, has been in the trenches with many health plans. In this seven-minute webinar, Michelle shares three key tactics you can employ… Continue reading Download our webinar, Best Practices: Three Key Steps to Minimize RADV Exposure
