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Creating Marketplace 2.0 Success Blueprint By now, the 2016 CMS Risk Adjustment and Reinsurance report has been published and we are all painfully aware of the “winner” and “losers” (those health plans who paid into the program and those who received payments). And with that, two of the 3Rs (risk corridors and reinsurance) have run their course, leaving risk adjustment as the only risk stabilizing mechanism operating in 2017 and beyond. https://www.edifecs.com/e/creating-marketplace-2-0-success-blueprint/

Creating Marketplace 2.0 Success Blueprint

By now, the 2016 CMS Risk Adjustment and Reinsurance report has been published and we are all painfully aware of the “winner” and “losers” (those health plans who paid into the program and those who received payments). And with that, two of the 3Rs (risk corridors and reinsurance) have run their course, leaving risk adjustment as the only risk stabilizing mechanism operating in 2017 and beyond.

#Consumer, #EnrollmentManagement, #Financial, #RevenueManagement, #RiskAdjustment

#Cost Sharing Reduction #Encounter Management #Marketplace 2.0 #Risk Adjustment

It Takes a Village: Processes constituting the EDGE Server operational and financial success The ‘process’ aspect, both operational and financial, is going to depend largely upon two things: submission acceptance rate and the achievement of financial goals as reflected in the Summary Risk Adjustment and Reinsurance Payment Report. http://www.edifecs.com/e/it-takes-a-village-processes-constituting-the-edge-server-operational-and-financial-success/

It Takes a Village: Processes constituting the EDGE Server operational and financial success

The ‘process’ aspect, both operational and financial, is going to depend largely upon two things: submission acceptance rate and the achievement of financial goals as reflected in the Summary Risk Adjustment and Reinsurance Payment Report.

#EncounterManagment, #Financial, #RiskAdjustment, #ValueBasedCare

#Edge Server #Edge Server Reporting #Encounter Management #Medicare Advantage #Reinsurance Payment Reporting #Risk Adjustment #Risk Score

Healthcare Weekly Newsreel – By Dawn Carter GE Healthcare has developed a pattern recognition software that serves as an “early warning system” for payers to analyze for patterns and correlations in denials. http://www.edifecs.com/e/healthcare-weekly-newsreel-by-dawn-carter-3/

Healthcare Weekly Newsreel – By Dawn Carter

GE Healthcare has developed a pattern recognition software that serves as an “early warning system” for payers to analyze for patterns and correlations in denials.

#EncounterManagment, #Financial, #ICD-10Readiness, #RiskAdjustment

#Encounter Management #ICD-10 #ICD-10 Impact #Risk Adjustment #Risk Scores

Healthcare Weekly Newsreel – By Dawn Carter - "All ICD-10, all the time" Though October 1st has come and gone, providers still have time to get ready for the changes that will be brought on by the new codeset. They have to be willing to embrace change, understand the importance of correct coding and documentation to prevent an uptick in denials, and understand that it is not just an IT system conversion; http://www.edifecs.com/e/healthcare-weekly-newsreel-by-dawn-carter-all-icd-10-all-the-time/

Healthcare Weekly Newsreel – By Dawn Carter - "All ICD-10, all the time"

Though October 1st has come and gone, providers still have time to get ready for the changes that will be brought on by the new codeset. They have to be willing to embrace change, understand the importance of correct coding and documentation to prevent an uptick in denials, and understand that it is not just an IT system conversion;

#EncounterManagment, #Financial, #ICD-10Readiness, #ValueBasedCare

#ACA Marketplace #Encounter Management #healthcare #ICD-10 #Risk Adjustment

It Takes a Village: People! “It Takes A Village, People!” – means that is going to take a village of the right people to maximize the chances of financial and operational success. Notice I said the “right” people. How do you know what is right for your organization? http://www.edifecs.com/e/it-takes-a-village-people/

It Takes a Village: People!

“It Takes A Village, People!” – means that is going to take a village of the right people to maximize the chances of financial and operational success. Notice I said the “right” people. How do you know what is right for your organization?

#EncounterManagment, #RiskAdjustment

#Edge Server Reporting #Encounter Management #Medicare Advantage #Revenue Integrity #Risk Adjustment

What's the Value? Across managed Medicaid, Medicare Advantage, the Marketplace and Duals, encounter management remains a critical challenge. http://www.edifecs.com/e/whats-the-value/

What's the Value?

Across managed Medicaid, Medicare Advantage, the Marketplace and Duals, encounter management remains a critical challenge.

#Compliance, #EncounterManagment, #Financial

#Encounter Management #Marketplace Healthcare #Medicare Advantage #Revenue Integrity

Healthcare Weekly Newsreel - Week Three– By Dawn Carter CMS has announced that they plan to offer very specific extra supplemental benefits or reduced cost sharing to Medicare Advantage enrolled members with specific chronic conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, among others. http://www.edifecs.com/e/healthcare-weekly-newsreel-week-three-by-dawn-carter/

Healthcare Weekly Newsreel - Week Three– By Dawn Carter

CMS has announced that they plan to offer very specific extra supplemental benefits or reduced cost sharing to Medicare Advantage enrolled members with specific chronic conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, among others.

#Clinical, #EncounterManagment, #RevenueManagement, #RiskAdjustment, #ValueBasedCare

#Encounter Management #ICD-10 #Medicare Advantage #Risk Adjustment #Risk Scores #Value-based care

Healthcare Weekly Newsreel – By Dawn Carter At the end of the special enrollment period for 2015, 12.7 million enrollees had selected coverage through the Marketplace. As of June 30, only 9.9 enrollees had effectuated their coverage. About 8.3 million of these enrollees were provided federal subsidies to assist with the cost of their premiums http://www.edifecs.com/e/healthcare-weekly-newsreel-by-dawn-carter-2/

Healthcare Weekly Newsreel – By Dawn Carter

At the end of the special enrollment period for 2015, 12.7 million enrollees had selected coverage through the Marketplace. As of June 30, only 9.9 enrollees had effectuated their coverage. About 8.3 million of these enrollees were provided federal subsidies to assist with the cost of their premiums

#Clinical, #EncounterManagment, #Financial, #RevenueManagement, #RiskAdjustment, #ValueBasedCare

#Encounter Management #ICD-10 #Medicare Advantage #Risk Adjustment #Risk Scores #Value-based care

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