• Implementing a post-encounter coding review is an effective way to ensure complete and accurate capture of all 2020 risk adjustable conditions - without burdening clinical teams - while informing care and stabilizing revenue. Finding and closing these gaps today, with fee-for-service revenues having bottomed out and many provider organizations in a precarious financial position, is especially critical.

  • Robin Lloyd, HF Chief Commercial Officer, envisions the longer-term impact on healthcare delivery, policy, and technology following the coronavirus pandemic.

  • In mid-December, the Health and Human Services Office of the Inspector General (HHS-OIG) announced that an investigation into Medicare Advantage organizations (MAO) had found $6.7 billion in potentially unsupported risk adjustment payments, generated from chart review programs that overwhelmingly yielded additional diagnoses. The study further found that 99% of chart reviews resulted in added diagnoses—not […]

  • Over 10% of the U.S. population is now covered by an accountable care organization (ACO), and the number of risk-adjusted lives is growing at roughly 15% to 20% each year. To date, risk adjustment has primarily consisted of payers retrospectively reconciling work done with payments owed. With the Medicare Access and CHIP Reauthorization Act (MACRA) […]