Health plans operating in healthcare’s changing landscape encounter many unknowns. With the passage of the Affordable Care Act, health plans who can collect the most accurate data on their member populations will improve their opportunities for financial, quality, and clinical improvements. Accurate coding and efficient medical record retrieval services are an effective way to manage the care, medical costs, and financial impact of risk-adjustable members.
By RaeAnn Grossman What are the new trends in Medicare Advantage risk adjustment and premium accuracy? Monthly reporting on your RAPS to EDS impact on RAF (monitoring your data compilation and completeness) Starting your in-patient medical record review as early as possible Conducting as many second level reviews as your budget allows; 2LR typically yields […]
By RaeAnn Grossman Pharma. The most interesting and accurate data for persistent and inferred conditions is pharmacy data. If you know your pharma data, you can create a member profile for retrospective, concurrent, and care targeting. Prescriptions are typically closely aligned with conditions, not always at a one-to-one ratio. Make certain you have the complete […]