Verisk Health
Verisk Health
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New blog articles detected.

  • improve medical record retrieval success by analyzing provider behavior patterns
    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

New blog articles detected.

  • thinking inside the box with a provider decision quadrant: monitoring provider network stability
    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

New blog articles detected.

  • infographic: analyzing 2017’s risk adjustment valuation to improve 2018’s processes
    How is your health plan setting its target return on investment (ROI) per chart for your 2018 retrospective risk adjustment program? We’ve found that many payers simply base their estimates on the previous year’s financial results with perhaps a few minor tweaks—but there are myriad program changes and other factors that should be considered holistically.
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • jumping the hurdles to value-based care
    The transition from fee-for-service to value-based healthcare, where payers compensate providers based on the patient’s quality outcomes, is still moving slowly. What are the major obstacles standing in the way of providers taking on more risk?
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • think inside the box on FWA: introducing the provider decision quadrant
    Sophisticated data analytics can process billions of claim code line edits at a rapid pace, 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 next step is ...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • can healthcare fraud special investigators keep up the pace?
    This week the U.S. Justice Department announced one of the biggest multi-agency healthcare fraud busts in history involving a total of 412 people, including almost 115 doctors, nurses, and other medical professionals. The alleged fraudsters were charged with defrauding Medicare, Medicaid, and TRICARE programs of $1.3 billion, billing for unneeded drugs and treatments that were often ne...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • NCQA’s new timeline is out—are you ready for HEDIS® 2018?
    Quality reporting is closely aligned with financial success for health plans across the country, amplifying the importance of keeping an eye on HEDIS metrics year-round. Although HEDIS measurement and reporting requirements and timelines are always subject to annual changes from NCQA, effective pre-submission planning streamlines the process and helps plans more easily achieve successf...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • amid healthcare reform, ACA risk stabilization goes on
    While the House and Senate attempt to re-write healthcare policy, the pressing problems that the Affordable Care Act (ACA) aimed to address are still at play and being managed by healthcare providers and payers alike, with a continued focus on how to manage the individual and small-group markets. The Senate delayed the vote on the latest bill, the Better Care Reconciliation Act of 2017...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • who canceled summer? why the HEDIS® 2018 season really starts now
    Ah, summer. Time to relax, pat yourself on the back for a job well done for HEDIS® 2017, and think about something else for a change. Or is it?   Summer’s not exactly cancelled, but you’d be wise to devote some time to a few key initiatives that will help you get a jump on HEDIS 2018.  
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • step up your game: how to improve risk adjustment coding accuracy
    The Office of Inspector General (OIG) sets the bar for coding accuracy at 95 percent, but you can’t achieve that goal without a comprehensive approach that gets it right from the beginning. Are you following best practices to ensure accurate code capture, or is there room for improvement? Here are some concrete steps you can start implementing today to step up your risk adjustment game...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • podcast: why value-based care requires “strength from all sides”
    As the transition from fee-for-service to value-based care continues to disrupt the healthcare industry, payers and providers must share data with each other—and increase transparency—to drive costs down. That was among the messages Verscend president and CEO Dr. Emad Rizk recently shared with the Red Hot Healthcare podcast, which features in-depth interviews with top leaders in the he...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • when waste becomes fraud: where do you draw the line?
    Under HIPAA, healthcare fraud is defined as “knowingly, and willfully executing or attempting to execute a scheme … to defraud any healthcare benefit program.” Unlike waste and even abuse, which are characterized by an unintentional practice that directly or indirectly results in an overpayment, fraudsters are distinguished by their intention to obtain monies that they are not otherwis...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • from the HEDIS® 2017 trenches: the final countdown
    As HEDIS® season comes to an end, you always seem to have an infinite number of things to remember to ensure your submission is accurate, locked on time, and approved by your auditor. In the last few days, you might have faced auditor questions, IDSS or PLD errors, executive team members who need status updates, or perhaps something new that you’ve never experienced before.
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • busted: the top fraud and abuse busts in Q1 2017
    Tens of billions of dollars are wasted each year thanks to fraudulent healthcare billing practices, according to the National Health Care Anti-Fraud Association (NHCAA). Exposing the toughest and largest cases often requires close collaboration between health plans, the Department of Justice, the Federal Bureau of Investigation, and the Centers for Medicare & Medicaid Services (CMS).
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • from the HEDIS® 2017 trenches: for MRRV success, don’t overlook over-reading
    Now that we have a second season with the new medical record review validation (MRRV) guidelines under our belts, were you better prepared this year? In the latest edition of our blog series, “from the HEDIS® 2017 trenches,” Carrie Taylor, Verscend’s manager for HEDIS abstraction, discusses what Verscend did this year to ensure MRRV success for our clients, and offers tips for health p...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • improving healthcare quality: four proven health plan strategies that providers should adopt
    The following article by Verscend President and CEO Dr. Emad Rizk was originally published by the HFM blog, a publication of the Healthcare Financial Management Association. As payments become more closely aligned with quality metrics in preparation for a value-based healthcare system, quality measurement and reporting will take on greater importance for healthcare organizations. What ...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • are you playing “whack-a-mole” with your performance improvement initiatives?
    In the past, payers’ approach to data analytics was more tactical than strategic. Analytics were deployed in a siloed fashion to answer a question about a specific area of the business—an approach viewed as sufficient to drive results. Today, however, payers are putting analytics front and center, using advanced analytic methodologies to guide sound business decisions.
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • how does data analytics curb healthcare spending?
    Despite the uncertainty surrounding what U.S. healthcare will look like five years from now—or maybe even five months from now—one thing is sure. The affordability of healthcare will continue to be a priority. How will payers meet this challenge? As Verscend President and CEO Dr. Emad Rizk wrote this month for Healthcare Innovation News, “it is imperative for healthcare organizations t...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • from the HEDIS® 2017 trenches: the importance of an admin refresh
    The HEDIS® 2017 season is more than halfway done. Are you on track for the reporting deadline? Our Verscend experts are here to share® their insights on effectively managing your measurement and reporting process in our monthly blog series, “from the HEDIS 2017 trenches.” Here, Jenna Fitcher, product director for Verscend’s Quality Improvement solutions, discusses best practices for th...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • the 2018 final payment notice: the top four takeaways
    After listening to public comments, the Centers for Medicare & Medicaid Services (CMS) has released its Final Notice for the 2018 Payment Year for Medicare Advantage (MA) and Part D plans—and there are significant changes from the Advance Notice released back in February. Verscend’s Sean Creighton, senior vice president of Risk Adjustment, breaks down what it means for payers.
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • from the HEDIS® 2017 trenches: tracking your retrieval and abstraction efforts
    The HEDIS® 2017 season is about halfway done. Are you on track for the reporting deadline? In the latest addition to our blog series, “from the HEDIS 2017 trenches,” Ashley McNairy, product director for Verscend’s Quality Improvement solutions, discusses best practices for tracking retrieval, abstraction, and measure rates.
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • RISE to the occasion: quality, risk adjustment, payers, and providers converge
    Although its Nashville location remains the same, the Annual RISE Summit continues to grow in size and importance each year. RISE, or the Resource Initiative and Society for Education, has been bringing its membership together for 11 years to address fundamental issues in risk adjustment, performance measurement and improvement, and payment integrity. The American Health Care Act, the ...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • busting myths about clinical claim review
    We know that automated claim editing is unable to analyze many claims due to their clinical complexity, the most obvious examples being claims with modifiers 25 and 59. These simply pass through the system and get paid without any further intervention. That’s why clinical claim review—also known as clinical validation—is so valuable. Clinical validation is a process whereby a team of c...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • watch: how big data and automation are disrupting healthcare
    How is the shift to value-based care creating a “perfect storm” for payers and providers to leverage big data as technology and automation evolve? And at the same time, how are these advances empowering healthcare consumers? Verscend’s own President and CEO Dr. Emad Rizk discussed these topics in depth recently at the 2017 Health Care Forecast Conference held at the Paul Merage School ...
Verisk Health
Verisk Health
Blog Post

New blog articles detected.

  • the art and science of handling Medicare risk adjustment coding “gray areas”
    While the Centers for Medicare & Medicaid Services (CMS) has guidelines in place for Medicare risk adjustment coding, that doesn’t mean that every Medicare Advantage plan will code the same way. In fact, there is room for many different approaches—and it’s up to each plan to decide what will lead to the best outcome. We caught up with Deb Bradley, Verscend’s senior vice president of cl...

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