Welcome to RISE

Resource Initiative and Society for Education

Welcome to the home of the Resource Initiative and Society for Education (RISE). RISE is the first national association totally dedicated to enabling healthcare professionals to meet the challenges of managed healthcare. We strive to serve our members on four fronts: Networking, Education, Jobs and Industry Intelligence. Please explore our website and the resources it provides. Those wanting to join the association are invited to complete and submit an application. Take a look at the benefits and services of membership. 

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Latest Posts

Where Coding Takes Us

Risk Adjustment and Controversy: Risk adjustment is a payment tool that is coming under greater levels of scrutiny, particularly given some recent journalism that presented a very slanted view of the practice as it relates to the popular Medicare Advantage program that provides health coverage to roughly 30% of Medicare beneficiaries. While this series of articles is critical of the health insurance industry, it mixes a string of worthwhile and valid points with a large dose of bad information and invalid accusation (http://www.publicintegrity.org/). Putting this into perspective requires more than tough soundbites. It requires some understanding of what the government and the industry are really trying to do and how they are going about it. ...
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Redefining Member Engagement

Today, it is especially critical for Health Plans to develop a solid plan and execution strategy for driving member engagement and loyalty. Health Plans acknowledge that it is more cost effective to retain first year members as opposed to enrolling new members. In order to increase member retention rates, it is imperative to begin to effectively engage each member at the point of enrollment. In-home health assessments are typically the first engagement effort Medicare Advantage Plans provide to their members, post-enrollment. These health assessments are not only focused on collecting ...
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Upcoming Conference

 

RISE California

You’ll hear directly from expert resources, including CMS and NCQA speakers and folks in the trenches who will share first-hand experiences. Plus, we’ve added a special session featuring the RISE Advisory Board and their take on CMS policy changes.

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Upcoming Webinar

CMS RADV Preparation Best Practices

In order to maintain payment integrity for the CMS HCC model, CMS performs national RADV to study the payment error rates. CMS also performs contract level RADVs for health plans with high risk score variation from year-to-year to recover overpayments.

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