News & Blogs

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 elements of the call letter, including new measures, weighting changes, display measures and what to expect in the coming years.

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Claims Systems- Build vs. Finance?

Lately, there have been many articles about health plans building administrative systems and/or financing claims systems.  At the same time, some of these same plans experiencing compliance issues, MLR challenges and problems meeting enrollment and retention expectations. These plans, if not building systems themselves, are actually financing solutions that are not built with the latest technology, nor are they complete end-to-end solutions. reinsurance (RI) and risk adjustment (RA) calculations. Read More…

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. Read More…

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. Read More…

How to manage 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 with a huge upfront investment. Read More…

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