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Tag Archives: censeohealth
Solving your claims-based HCC conundrum
Everybody knows that 37% of claims-based HCCs fail in a RADV audit, but no one ever talks about how to fix the problem.
Physician Engagement… What can you really do?
Health plans have tried a hundred ways to engage providers – incentive stipends, P4P, P4Q, capitation, clinical initiatives, episode of care payment, onsite coders, in office case management liaisons. But what works? Open communication, reasonable expectations, and simplicity.
Garbage In. Clarity Out
So you may have bad, ugly, horrible, scary data and internally you don’t have a means to lump it all together to give you a clear picture of what happened in 2010, 2011, and the challenges you are facing in 2012 with your members, your network physicians or your risk adjustment program.
The Goat Rodeo
You hear a lot of interesting comments when you are meeting with health plans and large medical groups. One of my favorite phrases is “last year was a goat rodeo.” The visual makes me laugh every time – goats, kids, and general goat chaos. However, in risk adjustment, you cannot afford an internal or vendor “goat rodeo.”
Medicare Advantage and Diagnostic Accuracy
There have been recent suggestions that Medicare Advantage plans are receiving excessive reimbursement from CMS as a result of “up coding” in the risk adjustment system. There are a number of reasons why these suggestions are inaccurate and counterproductive.
Your Risk Adjustment Road Map
Where are you going? And how quickly are you getting there?
The risk adjustment model is evolving rapidly because of RADV, EDPS, and your health plan competitors.
