Risk Adjustment

Risk Adjustment in Medicaid

Medicaid Risk Adjustment | Mile High Healthcare Analytics

Many people believe that risk adjustment started with Medicare Advantage in 2004, but actually Medicaid risk adjustment led the way, starting in Maryland and Minnesota in the late 1990’s and Colorado in 2000. Current State of Medicaid Risk Adjustment Today 36 states currently have risk-bearing contracts with managed care organizations (MCOs). At least 23 states use a risk adjustment model to adjust payments to these... Read More

CMS Announces Plans to Expand RACs to Medicare Advantage and Part D Plans

A tremor was felt across the healthcare industry as CMS released a request for information (RFI) that outlined the planned expansion of Medicare’s Recovery Audit Program. Under this program the government pays private recovery audit contractors (RACs) to assess medical records at hospitals and doctor offices to find instances of overpayment. The first set of audits, based on payment data for 2007, yielded $13.7M in... Read More

ICD-10 Transition Update

ICD 10 | Mile High Healthcare Analytics

Despite much nail biting and teeth gnashing in anticipation of the cutover to ICD-10, the apocalypse appears to have been avoided. To many in the industry, the October 1 transition to ICD-10 created a Y2K-like frenzy, and, like Y2K, it appears to be mostly a non-event. ICD-10 Code Quantity Explosion That is not to downplay the significance of this transition. The new ICD-10-CM diagnosis coding... Read More

RAPS Submission Deadline January 31, 2016

RAPS Deadline | Mile High Healthcare Analytics

January 31, 2016 is the final day for submitting new and corrected RAPS files to optimize your Medicare Advantage payments for 2015. There is still time for a third party review of your data to make sure your submission will yield the most accurate risk scores and premium payments from CMS. Mile High Healthcare Analytics helps clients determine if diagnosis codes that resolve to previously... Read More