Verisk Health
Verisk Health
Blog Post
  • The first three months of 2018 were unpredictable, to say the least, from record-breaking Nor’easters to bracket-busting March Madness results. Similarly erratic were last quarter’s top fraud busts, including kickback schemes, unnecessary surgery, and a racket that put dangerous opioids out on the street. With help from the National Health Care Anti-Fraud Association, we’ve compiled the top fra...

Verisk Health
Verisk Health
Blog Post
  • Medicare Advantage plans are still digesting the 2019 Medicare Advantage and Part D Rate Announcement and Call Letter, released last week by the Centers for Medicare & Medicaid Services (CMS). Here, Verscend’s Ashley McNairy, product director for Verscend’s Government Quality Solutions, breaks down the key changes to the Star Ratings program on the docket for 2019 and the potential impact on he...

Verisk Health
Verisk Health
Blog Post
  • The Centers for Medicare & Medicaid Services (CMS) has just released its final 2019 Medicare Advantage and Part D Rate Announcement and Call Letter. What are the key takeaways for Medicare Advantage plans when it comes to their risk adjustment programs? We dive in on “From the Trenches,” a new podcast from Verscend Technologies. Our guest on this episode is Lesley Brown, Verscend vice president...

Verisk Health
Verisk Health
Blog Post
  • In the third episode of our “From the Trenches” podcast, we look at several new measures and measure changes recently proposed by the National Committee for Quality Assurance (NCQA) for next year’s HEDIS season and how they would impact health plans. NCQA recently held a month-long public comment period for health plans and other stakeholders to weigh in on the proposed changes.

Verisk Health
Verisk Health
Blog Post
  • Emad Rizk, M.D., joined Verscend Technologies a year and a half ago as president and CEO. He took a few moments recently to share his perspective on the company, its recent acquisition of commercial payer products and services from General Dynamics Information Technology, and the employee characteristics that fuel rapid company growth.

Verisk Health
Verisk Health
Blog Post
  • In the second episode of our “From the Trenches” podcast, we discuss the results of a new Verscend survey on the changing quality improvement landscape. As payers increasingly use quality data to drive performance improvement initiatives across their organizations, Verscend conducted the survey of health plan quality departments in late 2017 to determine how organizational shifts are affecting ...

Verisk Health
Verisk Health
Blog Post
  • The Centers for Medicare & Medicaid Services (CMS) has released its advance notice of proposed changes to the Medicare Advantage (MA) risk adjustment model for the 2019 calendar year (CY 2019). These changes are in line with the agency’s continued commitment to ensure MA payments accurately reflect the relative health risk and actual expected healthcare costs of plan beneficiaries. In addition,...

Verisk Health
Verisk Health
Blog Post
  • When Santa made his list this past Christmas, the vast majority of healthcare providers were nice, but a small handful of them were … fraudy. Okay, that was a pretty bad joke, but not nearly as bad as the alleged healthcare fraud schemes that the National Health Care Anti-Fraud Association compiled from October through December 2017. Here’s our round-up of the top five busts made by the feds in...

Verisk Health
Verisk Health
Blog Post
  • You can’t have a conversation about healthcare quality without talking about HEDIS®, which has played a pivotal role in the industry for more than 25 years. Once thought to be nearly impossible, quality measurement is now a critical component of the industry’s transformation to value-based care delivery and payment systems.  Inside health plan board rooms, however, there’s a growing realizati...

Verisk Health
Verisk Health
Blog Post
  • Last week, the National Committee for Quality Assurance (NCQA) informed health plans, vendors, and auditors that it has decided to suspend the requirements for the Patient Level Detail (PLD) files for Medicaid, Marketplace, and commercial populations for HEDIS® 2018. The organization noted that the decision was a direct response to “comments about the number of measures and the burden ...

Verisk Health
Verisk Health
Blog Post
  • In the 2017 payment year, the 25 percent Encounter Data System (EDS) contribution and its impact on risk scores and associated revenue have challenged Medicare Advantage (MA) plans, which have much more experience submitting Risk Adjustment Processing System (RAPS) data. The difficulty of submitting data via EDS and getting the Centers for Medicare & Medicaid Services (CMS) to accept h...

Verisk Health
Verisk Health
Blog Post
  • Sophisticated data analytics can process billions of claim code line edits through the course of the day, helping payers identify hundreds of providers with aberrant billing patterns with each pass of the data. However, this is just the first step in a resource-intensive process to determine whether fraud, waste, and abuse (FWA) have actually occurred—and then, what to do about it. The...

Verisk Health
Verisk Health
Blog Post
  • Visiting a corn maze on Halloween can be fun, but trying to navigate the transition from RAPS to EDS has been more like a house of horrors for Medicare Advantage plans. Revenue loss has been a major concern for health plans due to the difficulty of submitting data via EDS and getting the Centers for Medicare & Medicaid Services (CMS) to accept it. This challenge, coupled with the recon...

Verisk Health
Verisk Health
Blog Post
  • The National Committee for Quality Assurance (NCQA) has released its HEDIS® 2018 Technical Specifications Update, closely tracked by health plans, auditors, and quality reporting and analytics vendors. Jenna Fitcher, product director for Verscend’s Quality Improvement solutions, breaks down the key takeaways.

Verisk Health
Verisk Health
Blog Post
  • From California to New York, fraud and abuse took no vacation over late spring and summer this year. The National Health Care Anti-Fraud Association has collected some of the top healthcare fraud busts from May to September 2017, representing schemes in home healthcare, pill mills, sober homes, and many more. Here’s our round-up of the top 10.

Verisk Health
Verisk Health
Blog Post
  • Remember Aesop’s Fables? They may be thousands of years old, but the moral of each tale is just as relevant today. One of the most famous fables, “The Ant and the Grasshopper,” tells of a careful ant that stored up food for the winter. The grasshopper put this task off until the last minute and would have starved during the winter if not for the ant’s help. The moral to the story: “It’...

Verisk Health
Verisk Health
Blog Post
  • Medical record retrieval is labor intensive, consumes time and resources, and requires great patience and persistence—but it’s a crucial component of any risk adjustment or HEDIS® project. Is there a way for health plans to increase their retrieval success rate without simply throwing more money at the problem? How can they ensure they’re getting the best return on investment (ROI) in ...

Verisk Health
Verisk Health
Blog Post
  • As we’ve explored in earlier blog posts, the provider decision quadrant uses two dimensions—fraud likelihood score and 12 months of paid claim exposure—to classify providers into four groups based on whether they are high or low risk and high or low cost. This framework allows health plans to better understand often subtle differences in provider risk profiles and tailor their fraud, w...

Verisk Health
Verisk Health
Blog Post
Verisk Health
Verisk Health
Blog Post
  • So far in our blog series on the provider decision quadrant, we’ve explained how this tool helps health plans fine-tune how they identify and prioritize potential fraud, waste, and abuse (FWA) in their provider networks, and also performed a close examination of providers who reside in the low-risk quadrants. In this blog post, we’ll zero in on the high-risk quadrants, where payers alr...

Verisk Health
Verisk Health
Blog Post
Verisk Health
Verisk Health
Blog Post
  • Recently on the Verscend blog, we introduced the concept of a provider decision quadrant to help health plans fine-tune the prioritization process when it comes to addressing potential fraud, waste, and abuse (FWA) in their provider networks. Replacing the more traditional approach of simply examining the fraud likelihood score, Verscend has found that by plotting providers in a quadra...

Out-Market Your Competitors?

Get complete competitive insights on over 2.2 million companies to drive your marketing strategy.

Create Free Account Log in

By signing up, you agree to the Terms of Service and Privacy Policy.

Out-Market Your Competitors

Get complete competitive insights on over 2.2 million companies to drive your marketing strategy.

Create Free Account

Already a user?  Log in

By signing up, you agree to the Terms of Service and Privacy Policy.