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How Provider Analytics Can Help Manage Risk and Optimize Revenue

Everything you need to know to: Close gaps between diagnosis, quality scores, and revenue; Enable providers to better manage risk; Shorten turnaround between providers and payers to 24 hours; and provide more complete data to providers at the time of care.

CMS, Overpayments, and the Final 60-Day Rule

What Medicare Advantage Organizations, health plans, and other affected groups need to know (and do) if they want to comply with the new overpayments rule – including how to establish and enforce effective policies and procedures, deploy advanced algorithms to identify overpayments, educate providers, and develop an overarching strategy that protects against the serious consequences of overpayments.

Demystifying CMS’ New Risk Adjustment Scoring System

An enormous change is sweeping through health plans and Medicare Advantage Organizations (MAOs): Centers for Medicare and Medicaid Services (CMS) is beginning to incorporate diagnoses from CMS’s Encounter Data System (EDS) into the risk scores used in payment, slowly transitioning away from the more basic Risk Adjustment Payment System (RAPS).