Risk Adjustment/Coding Toolkit
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Recording: 2017 Alliance Coding Work Group: Paramount case studies
This call is one in a series designed for the Alliance coding work group. These calls showcase one health plan at a time, whose team is responsible for sharing multiple coding case studies with the other group members for discussion.
Recording: Risk Adjustment Round table Discussion April 2017
On the last Friday of each month, risk adjustment leaders from Alliance member health plans and their provider partner entities come together to discuss timely issues during an open round table discussion.
Coding Chronic Conditions from PMH
list of chronic conditions from the CMS Participant Guide that may be coded with evidence of TAMPER; this would include medications from a medication list that could only be prescribed for one of these conditions, even if the provider does not document the association in his or her assessment.
Recording: Case study - The RFP process for a risk adjustment vendor
In this encore presentation from the February 2017 Risk Adjustment value visit, MediGold shares more details regarding its search and selection process of a vendor to support the health plan's risk adjustment goals.
Presentation: Case study - The RFP process for a risk adjustment vendor
In this encore presentation from the February 2017 Risk Adjustment value visit, MediGold shares more details regarding its search and selection process of a vendor to support the health plan's risk adjustment goals.
Presentation: Risk Adjustment Round table Discussion: April 2017
Dean Ratzla, Actuary, Sentara Health Plans (Optima) shared the financial metrics used by his plan to communicate the financial value of its risk score optimization (RSO) activities and the formula for calculating the value of an incremental HCC.
Coding Work Group Case Studies:April 2017
Case studies shared by Paramount with the Coding Work Group for discussion of coding best practices.
2017 HHS RADV IVA Auditor Report: 2015 Audit
In q1 2017, the Health Plan Alliance invited member plans to share their experience with IVA vendors, and results were reported out in March 2017.
Recording: Risk Adjustment Roundtable Discussion: March 2017
On the last Friday of each month, risk adjustment leaders from Alliance member health plans and their provider partner entities come together to discuss timely issues during an open round table discussion.
Presentation: Risk Adjustment Roundtable Discussion: March 2017
On the last Friday of each month, risk adjustment leaders from Alliance member health plans and their provider partner entities come together to discuss timely issues during an open round table discussion.
Recording: 2017 Alliance Coding Work Group - Health Alliance Medical Plans case studies
This call is one in a series designed for the Alliance coding work group. These calls showcase one health plan at a time, whose team is responsible for sharing multiple coding case studies with the other group members for discussion
Audio: Coding Work Group February 2017 in Orlando
Case studies shared by Health Alliance Medical Plans with the Coding Work Group for discussion of coding best practices.
Coding Work Group Case Studies: March 2017
Case studies shared by Health Alliance Medical Plans with the Coding Work Group for discussion of coding best practices.
Presentation: The lifecycle of beginning a new vendor relationship
This session, presented by Amber Harris, Director Risk Adjustment with MediGold and Pulse8, explores the search, selection and implementation of a new vendor relationship to support an organization's efforts in risk adjustment.
Presentation: EDPS and RAPS reconciliation - homegrown solutions
This session explores the homegrown solutions some member plans have employed and invites conversation regarding the pros and cons of vendor vs in-house approaches to this critical function
Recording: 2017 Alliance Coding Work Group - Aspire case studies
This call is one in a series designed for the Alliance coding work group. These calls showcase one health plan at a time, whose team is responsible for sharing multiple coding case studies with the other group members for discussion.
Risk Adjustment Department Structure Best Practices
Overview of the organization structure, staffing, policies and procedures, the core systems usde to support your Risk Adjustment Department and the specific function that the system serves, and unique tools developed in your department to help improve work flow or project management.
Medicare Advantage & HCR Revenue Management Org Chart
Org Chart for HAP MA & HCR Revenue Management Team
Risk Adjustment Coding Compliance Guidance Policy (D-EDR-RAPS08A)
To improve the quality, accuracy and integrity of member data as it relates to reporting the health status of our members and to ensure minimal variation in medical coding practices. To ensure that Health Alliance Plan and Alliance Health and Life are collecting and submitting Medicare Advantage Risk Adjustment Data in accordance with the Centers for Medicare and Medicaid Services (CMS) requirements for Medicare Advantage members. Health Alliance Plan and Alliance Health and Life is committed to establishing and maintaining clinical coding procedures to ensure that reported codes accurately reflect the health status of our members.
Risk Adjustment Coding Compliance Guidance Procedure (D-EDR-RAPS08B)
To improve the quality, accuracy and integrity of member data as it relates to reporting the health status of members and to ensure minimal variation in coding practices.