Encounter Data System (EDS) Submissions for MA Supplemental Benefits
Brandon Solomon,
EDS is the single source of information used by CMS to calculate risk scores and the initial, mid- and final-year payments to MAOs. Introducing supplemental benefit data, which will not impact risk scores or financial payments, adds a complicating factor to an already complex encounter data submission process.Read
Convey Health Solutions Names Dan Finke as Chief Executive Officer
Convey Health Solutions (Convey), a leading healthcare technology and services company, has appointed healthcare executive Dan Finke as chief executive officer. Finke succeeds Stephen Farrell, who has served the company for more than a decade.Read
Improve Data Ownership to Fast-track Your Risk Adjustment Strategy
Pareto Intelligence,
There are key areas of your risk adjustment program worth examining closely when reviewing your analytic progress.Read
Avoiding Inaccurate CMS Data Submissions and Supercharging Your Data Process
Pareto Intelligence,
To ensure accurate encounter data, it's important to have a thorough understanding of the data process. Address systemic issues early to avoid spending administrative resources on closing gaps year after year.Read
Interactive Analysis: 2022 ACA Risk Adjustment Transfer Payment Results
Austin Bostock,
Fiona Dassum,
Analyze the results of 2021 ACA risk adjustment transfer payments by issuer and state through an interactive dashboard.Read
Pareto Insights: Medicare Advantage Payment Year 2024 Model Update (v28)
Our review of these model changes (v24 to v28) and the estimated potential impact for your health plan.Read
The Latest CMS Ruling: What This Means for Medicare Advantage Organizations
On January 30, 2023, CMS finalized a new rule to overhaul risk adjustment audits performed on MA plans. This ruling directly impacts the CMS’ Risk Adjustment Data Validation program, which focuses on the substantiation of diagnostic information submitted for risk adjustment consideration.Read
Risk Adjustment Priorities: Connecting Medicare Advantage Supplemental Data & Encounter Data
Rick Monaco,
Regularly re-evaluating your risk adjustment strategy ensures taking the appropriate steps to mitigate potential exposure to audit findings.Read
The Age of Audits: Why You Need to Re-evaluate Your Risk Adjustment Strategy
Rick Monaco,
Under rising pressure, organizations need to revamp their risk adjustment strategies to mitigate any potential exposure to audit findings.Read