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New Risk Adjustment Members and How to Impact Them

New membership for a Medicare Advantage Organization can result in statistically lower risk scores resulting in lower payments. However, the right Risk Adjustment strategy can enable Plans to accurately report risk scores and receive the correct reimbursement for these Read More

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Changes Within Stars for CMS Final Call Letter for Medicare Advantage Part C & D

The Centers for Medicare & Medicaid Services (CMS) released the Final Call Letter on April 1, 2019. The Call Letter solidifies some of the proposed changes that were included in the Part 1 Advance Notice. The following details highlight the key takeaways within the Stars elemen Read More

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Claims Systems- Build vs. Finance?

As Advalent’s new CEO, former CTO of one of the largest telehealth companies, and Founder and CEO of one of the early EMR companies, I have had many conversations with health plans about the pressure to build and/or finance claims administration systems. I then see some of these same pl Read More

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Advalent Supports CMS Edge Server Data Reporting on Amazon Web Services (AWS)

To the relief of some health insurers and the frustration of other payers, Centers for Medicare and Medicaid Services (CMS) recently announced the option for healthcare insurers to use the Amazon Web Services (AWS) cloud to host edge server data reporting for CMS reinsurance (RI) and risk adjustment (RA) calculations. Edge server data submi Read More

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ICD-10 Transition: Coding for ICD-9 and ICD-10 at the Same Time

As the U.S. stumbles forward in the transition from ICD-9 to ICD-10 diagnoses and inpatient procedure codes for healthcare services, U.S. health plans are stuck in limbo. ICD-9 will continue to be required until at least October 1, 2015, before it is replaced by ICD-10. In the meantime, health plans looking to implement a healthcare IT rep Read More

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Managing ACO cash flow and reap Medicare Shared Savings rewards

Many early Medicare Accountable Care Organizations (ACOs) are experiencing cost-flow challenges and data problems, reports Healthcare Payer News. ACOs need healthcare IT solutions to track and demonstrate the quality of their provider healthcare and care delivery costs, but IT healthcare solutions are often very expensive and require Read More