• Calling 2020 disruptive to healthcare is an understatement. But 2021 offers some unique opportunities to become a year of optimized risk adjustment. With the signing of the American Rescue Plan Act of 2021, barriers and premiums for COBRA have been reduced or eliminated, there are new Medicaid expansion incentives, and the ACA marketplace has an […]

  • Our latest ebook, Pulling Both Levers: A Four-Year Analysis of Medicare Cost and Risk Adjustment, unpacks the critical, and often overlooked, importance of effective risk adjustment done in conjunction with medical expense reduction under value-based care.

  • Using a workflow enabled by technology that enables, and actively supports, both additions and redaction (deletion), isn’t just easy and cost effective, it has value beyond its intrinsic ROI. Chris Gluhak explains the importance of eliminating inaccurate codes while looking for potential additions to avoid CMS penalties in audits.

  • 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.

  • 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) […]

  • Introducing 360-Degree Risk Adjustment - a strategic approach that considers risk adjustment optimization from all angles, including technology modernization, enhanced provider collaboration, departmental integration, and performance management.