Medicare Advantage RADV Rule May Prompt More Legal Action from Payers
- Payers have not reacted lightly to the Medicare Advantage Risk Adjustment Data Validation (RADV) final rule. Major payer Humana made the strongest display of disapproval by filing a lawsuit against CMS that seeks to invalidate the regulation. More payers are expected to follow Humana’s lead. In the meantime, Medicare Advantage organizations should focus on having complete...
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HHS Finalizes Medicare Advantage Risk Adjustment Data Validation Program Rule
The US Department of Health and Human Services (HHS) has released a final rule that aims to introduce more oversight into the Medicare Advantage risk adjustment data validation and payment...Provider Orgs Join Full-Risk Value-Based Care Contracts with BCBSM
Blue Cross Blue Shield of Michigan (BCBSM) is helping advance the shift to value-based care by initiating full-risk reimbursement arrangements with six provider organizations. The agreements are for...4 Tools for Managing Risk in Medicaid Managed Care Organizations
States have four main tools at their disposal for managing risk in Medicaid managed care organizations, according to a MACPAC issue brief. Medicaid managed care organizations are reimbursed in a...Sponsored Article
Closing Gaps in Care with Advanced Interoperability Capabilities
For health plans participating in risk-based agreements, gaps in care have serious implications for the health outcomes of members and their ability to attain higher quality scores necessary to receive...Sponsored Article
Leveraging Patient Access APIs to Optimize Risk Adjustment Efforts
Understanding the risk profile of their member population is essential for payers participating in Medicare programs. Risk adjustment allows the Centers for Medicare & Medicaid Services (CMS) to...Sponsored Article
Why Payers Must Go Beyond Compliance with the Interoperability Rule
The Interoperability and Patient Access Final Rule presents a near-term challenge for payers in terms of compliance with its provision for data access and sharing. It provides an opportunity for health...Sponsored Article
