On December 27, 2017, CMS published Part 1 of this year’s Medicare Advantage (MA) Advance Notice highlighting proposed changes in MA payments for 2019. CMS requires comments on this Part […]

This article details how coders can enhance their careers by becoming proficient in the finer points of the latest payment methodologies.

Find out how technology can help identify & remove waste so the focus can shift to care quality.

Value-based payment models are attracting attention for risk adjustment methodologies, especially HCC risk adjustment, which is used to calculate cost benchmarks for Medicare Advantage and other CMS payment models including […]

While Congress is finding it difficult to reach consensus on how to improve health care in the United States, the one thing we all can agree on is that ever-rising […]

Shifting from volume-driven to value-based healthcare wouldn’t be so difficult if value meant just one thing. But every payer and value-based program defines value to suit its own purposes—on good […]

The results of a recent study from the University of Michigan’s Institute for Healthcare Policy and Innovation on payment rewards and penalties for Michigan hospitals participating in the Medicare Comprehensive Joint […]

Last month, an article appeared in Modern Healthcare lauding the achievement of New York’s Bellevue Hospital in reducing readmissions to their facility. The article raised a number of issues relating […]

So much hope is invested in health data. As technology zooms into the 21st century (wearables, predictive modeling, precision medicine), health data organizations are scrambling to keep up. The promise […]

Let’s assume you’re about to sign a contract to manage a population of several thousand. The goal of the contract is to improve care delivery, improve outcomes and reduce the […]

In developing our classification tools we are continually called upon to make judgement calls on the relative clinical complexity of individuals and the interaction between comorbid chronic conditions on quality […]

Improving the rate of mammography or colorectal cancer screening for appropriate individuals is a good thing. I suspect that my experience in practice was similar to others: Our group would […]