risk adjustment

Q&A: Strategic payer initiatives at the intersection of risk and quality

Cotiviti’s Signature Series features interviews with senior healthcare industry leaders on how to improve clinical and financial outcomes in healthcare. The COVID-19 pandemic served to accelerate healthcare trends and has led many payers to reevaluate how they engage members in meaningful ways that will ultimately result in better outcomes. By working in unison, risk adjustment …

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Top 5 Medicare Advantage plan changes coming for 2022

The greatest uncertainty is members’ health status, which could impact MA organizations’ bidding submission process for 2022. Fortunately, fully vaccinated members are likely to resume in-person care this year, which means MA plans can expect a more consistent and reliable stream of data to form financial projections.

How to turn in-home assessments into “close encounters of the right kind”

Health plans complete in-home health assessments (often called health risk assessments) for their members for several reasons: accurately documenting members’ risk burden, supporting care management initiatives, and improving member engagement with the health plan, to name a few. But plans that don’t optimize their in-home assessment processes can lose out on valuable opportunities to improve …

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CMS releases ACA risk adjustment transfer payments and HRADV adjustments for 2019

The Centers for Medicare & Medicaid Services (CMS) recently released the health plan-specific 2019 benefit year risk adjustment transfer payments. As part of the Affordable Care Act (ACA), these payments move money from health plans that serve healthier populations to those with sicker members. Based on last year’s results, these transfers total $10.8 billion ($5.4 …

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Mitigating the impact of COVID-19 on risk adjustment and quality scores

As routine medical services are cancelled or postponed due to COVID-19, prospective risk scores used to pay Medicare Advantage (MA) health plans in 2021 are trending lower than forecasted. Additionally, risk scores for the Health and Human Services (HHS) model used by the Affordable Care Act (ACA) for commercial plans are also trending lower than …

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Laying the foundation for commercial risk adjustment success amid COVID-19

The core of a successful risk adjustment program is fully understanding your members as well as the various data exchanges that take place along the risk adjustment continuum. But the COVID-19 pandemic has introduced new challenges to optimizing risk adjustment revenues while maintaining compliance. Read this checklist for our suggested tactics.