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

Is Ambiguity Our Friend Any More?

I have heard from some plans that they relish the flexibility that ambiguity grants them to “sail closer to the wind” when it comes to policy decisions regarding HCC coding. It permits them to harvest more diagnoses and the revenue that they bring, which all kinds of good things for maintaining rich plan benefits and lower premiums to compete in the market. Isn’t that a good thing? Well, maybe not....
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News Update on CMS RADV Findings

Center for Public Integrity Publishes Latest News on RADV Audits Fred Schulte published the most recent article in his continuing series regarding the Medicare Advantage risk adjustment data validation audits. Check out the article: http://www.publicintegrity.org/2015/07/10/17634/more-medicare-advantage-audits-reveal-overcharges Based upon the results from a Freedom of Information Act filing and subsequent court order, it appears that CMS has released some information that previously was unavailable to the public regarding four healthplan audits, in addition to one recently released regarding PacifiCare of Washington. The key issue here is the CMS findings regarding the failure of chart audits to validate the diagnosis originally submitted to CMS in RAPS data. ...
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Upcoming Conference

 

RISE Nashville

Entering its 10th year, the RISE Nashville Summit has become the most comprehensive learning event for Medicare Advantage plan, Commercial plan, and provider group senior leaders dedicated to Quality Improvement, Risk Adjustment, Analytics and Care Management initiatives.

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Upcoming Webinar

Quality Rating System (QRS): Strategies to Prepare for 2016

In this webinar, you’ll get an overview of the QRS program, requirements and implications and gain insight on lessons learned from the beta-testing reporting year. Additionally, our expert speaker will discuss key strategies and best practices to successfully prepare for QRS program launch in 2016. 

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