Verisk Health
Verisk Health
Blog Post
  • You’ve submitted your final data to NCQA and CMS, marking the end of the HEDIS® 2018 marathon. Now it’s on to the next challenge: Star Ratings performance. In the latest episode of Verscend’s “From the Trenches” podcast, we wrap up this year’s HEDIS season, discuss the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System, and introduce Star Navigator, a new solution to...

Verisk Health
Verisk Health
Blog Post
  • While the cause of the rise in asthma and allergy rates over the past several years isn’t 100 percent clear, one of the effects is certain: a notable increase in billing and payment of allergy and asthma codes. And some providers are exploiting the high reimbursement rates and limited oversight associated with these codes, obtaining payment for services that may not be medically necessary or pr...

Verisk Health
Verisk Health
Blog Post
  • In the complex world of risk adjustment, health plans rely on suspect analytics to identify members with possibly undocumented conditions that could yield additional revenue. However, traditional suspecting approaches that rely solely on clinical rules may yield only the “low-hanging fruit” of hierarchical condition categories (HCCs). Rapid advancements in machine learning technology have produ...

Verisk Health
Verisk Health
Blog Post
  • The countdown is on for the June 15 deadline to submit your HEDIS 2018® data, and there’s no shortage of details to keep track of to ensure your submission is accurate, locked on time, and approved by your auditor. In the latest episode of Verscend’s “From the Trenches” podcast, we hear from Verscend product manager Jamison Gillitzer and senior data analyst Charan Govind, who offer important re...

Verisk Health
Verisk Health
Blog Post
  • Automated claim editing systems are a crucial component of accurate and efficient claims payment. But there will always be claims that are too complex to be auto-adjudicated and need a human touch. So, what exactly do you need to clinically validate a claim? In the latest episode of Verscend’s “From the Trenches” podcast, we talk with Kris Jensen, registered nurse and clinical consultant for Ve...

Verisk Health
Verisk Health
Blog Post
  • Last week, Verscend was honored to sponsor and participate in the 2018 Health Datapalooza conference in Washington, D.C., a gathering of top public- and private-sector leaders discussing how data and technology can improve health for individuals and communities. Here, Verscend chief analytics officer David Costello re-caps the event’s hottest topics.

Verisk Health
Verisk Health
Blog Post
  • The HEDIS® deadline for submitting your medical record review validation (MRRV) data is earlier this year. Are you prepared? On the latest episode of our “From the Trenches” podcast, our monthly dive into HEDIS 2018 continues as we get tips for MRRV success from Carrie Taylor and Holly Conk, who oversee Verscend's HEDIS abstraction team.

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.

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