cms risk adjustment sweeps

CMS regularly changes its risk adjustment model and risk adjustment factors.
Quick math leads me to think these 5 colleagues were in danger of leaving about 100M on the table for artsonia coupon codes 2014 Medicare Advantage.Recently, I received 5 separate calls from health plan and services vendor colleagues asking me if I had an extra 20-30 resources to support reviewing records during the last weeks of January sweeps (and now through May).CMS transitions from its Risk Adjustment Process System (raps) to its Encounter Data Processing System (edps) as it seeks to base risk adjustment payments on more detailed records.A wellness checkup at the start of the payment year can help you substantiate prior diagnoses with additional documentation.My team is going on vacation.If you were like me, you still waited until Sunday night at 9pm to finish the paper.Yes, that is a real thing.Why pay to retrieve them if they cant be reviewed?Follow these CMS risk adjustment best practices to drive complete, accurate and timely revenue generation.Identify members that represent the greatest opportunity and start with those.While youre at it, ask your dabs ie discount code providers to reconcile their directory data with you.Accuracy is also vital since risk scores are increasingly based on encounter data.Ive listened to what our colleagues are saying, and there are mixed opinions on whether or not to take action.We werent close enough to hitting our Risk Adjustment (RA) budget or RAF score, so we needed to go to the next tier of prioritized records.Our vendor barely had capacity to review more records with the original deadline, because they received an influx of requests from all its clients.Risk Adjustment Coding, experienced in hedis abstraction, and versed in the regulatory requirements from both CMS and ncqa.For those plans and communities impacted by extreme weather in 2017, this is a lifeline.If you didnt get records from your first round that you know will have a significant impact on your Risk Adjustment Factor (RAF) score, ask again.If you already had retrieval dates set for ACA, pickup MA records in that office whenever possible just make sure to be compliant.You must ensure that your encounter data is accurate in order to preserve, or perhaps increase, the amount of your monthly risk adjustment payment.Our clients never have to worry about capacity or cost because we design and construct your clinical team based on historic retrieval and review patterns, your work plans, and your strategies, and we do it all within your existing technology platforms.
The deadline for CMS risk adjustment data for the initial risk score run for payment year 2017 is Sept.
1) Beware of regulatory changes.


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