Events

 

The RISE Star Ratings Performance and Analytics Forum

December 5-6 - Las Vegas, NV

With CMS setting high stakes and moving targets for Star Ratings, it is more important than ever to develop a winning Stars game plan that will revamp your operational strategies, enhance your data gathering and analytics execution, and drive your quality goals forward.  Join us for this exceptional two-part program!  

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The Advanced CDAG Mock Audit and MAPD Compliance Summit

December 8-9 - Austin, TX

With an intense focus on the most challenging CMS audit elements, you will get best practices for monitoring your PBM and their downstream entities, administering fully compliant beneficiary notices, learn what critical preparations you should be making in light of the MTM universe pilot, and so much more!

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2nd Annual Medicare Secondary Payer Master Class

January 23-25 - Dallas, TX

Designed for all MSP stakeholders in the Non-Group Health Plan arena, this conference will provide tips and feedback to reinforce best practices for mandatory insurer reporting, conditional payments, and Medicare-Set Asides. Plus, CMS will be joining us to kick off the conference with legislative updates and answer your most challenging MSP questions during a facilitated question & answer panel.

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The Medicare Advantage Bidding Bootcamp

January 23-25 - Dallas, TX

HPMS. BPT. PBP. PBM. NABA.  Are you eager to tackle your plan’s Medicare Advantage bid, but feel like you’re swimming in acronym soup?  Not to mention drowning in the thousands of pages of instructions, templates, workbooks, and notices and call letters of both advance and final varieties?

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Medicare Advantage Accouting and Reconciliation 101 Bootcamp

January 30-31 - Nashville, TN

HPMS. BPT. PBP. PBM. NABA.  Are you eager to tackle your plan’s Medicare Advantage bid, but feel like you’re swimming in acronym soup?  Not to mention drowning in the thousands of pages of instructions, templates, workbooks, and notices and call letters of both advance and final varieties?

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Latest Posts

Keep M.E.A.T. on Your List for a Healthy Audit

By Jeanmarie Loria, Advize Health, LLC If you’re reading this article, chances are you already know what HCC Coding is – but we’ll give you a refresher anyway. Hierarchical Condition Category (HCC) and Risk Adjustment Coding is a CMS-mandated payment model. This model works to identify those with chronic and other serious illnesses and prescribes a risk factor score to each patient, taking into consideration their ailments and other demographics. With every payment model comes a specific set of audit and review requirements that must be met to maintain the integrity of the system, and this is where MEAT (Monitor, Evaluate, Assess/Address, Treat) comes in handy. In a face to face visit M.E.A.T. maybe found in the chief complaint, history of present illness, review of systems, physical exam, assessment and/or plan....
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Getting It Right: True North in Healthcare Reform

The movement to repeal and replace "ObamaCare" created so much political noise that clear thinking has been hard to come by. The 2010 legislation that created the marketplace for individuals and small business (the Affordable Care Act or ACA), has almost evolved into a political Rorschach test. The more that politicized options and alternatives to repealing, replacing, or repairing it were discussed, the harder it was to put into focus the original problems the legislation was designed to address. Nevertheless, the rancorous divisions over what needs to happen to fix problems in the individual insurance market remain a distraction from the real issue at hand: the cost of healthcare weighing down the economy and what we need to do to fix it. With all the intense debates swirling around this topic, an impression emerges that “solving the ObamaCare issues” is something that must be accomplished as an isolated matter, discrete and independent of other problems. The heated debates concentrate on the mechanics and tactics required to solve the "uninsured problem", the "under-insured problem", and for some, the federal budget problems created by the subsidies for low-income enrollees in these plans. This single-issue mono-vision obscures a reality that must be addressed. This perspective completely misses the fact that something is going on that is far more corrosive to the wellbeing of all of us as consumers of health care, as taxpayers, and as a nation: something that overshadows the tug ‘o war over ObamaCare. The critical and overlooked issue is that health care expenditures in the U.S are at least twice as expensive as other nations, which consume so much of the national economy...
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Upcoming Conference

 

Qualipalooza: The 2nd Annual RISE Quality Leadership Summit 

This unique event incorporates three conferences presented side-by-side: the Star Ratings Strategic Planning Forum, the HEDIS Forum, and the CAHPS, HOS & Member Survey Forum. Register for one conference for an in-depth examination of a single area, or design your own event by opting for the all-access pass and choosing the sessions from each conference which correspond exactly to your interests.

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Upcoming Webinar

Successful and Meaningful Techniques for Integrating Risk and Quality Interventions

Quality measurement and risk adjustment regulations are increasing and the financial impact upon health plans is progressively driving accountability and influencing profitability through payments, penalties, and bonuses. To improve performance and optimize risk and quality payments, Health Plans need to streamline processes, employ best practices for data capture, and focus on strategic interventions that use a member-centric approach.  

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