Printed materials, educational question and answer sessions, and dedicated, live resources are all part of my employer-sponsored insurance (ESI) annual open enrollment experience. I take advantage of this enrollment assistance each year and would be lost without it. The same holds true for the hospital patients and health plan members Centauri Health Solutions (“Centauri”) assists…

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There have been a lot of changes with HEDIS® for MY2020.  We’ve highlighted key changes in the Volume 2 specifications until the final changes become available on October 1. The first change to note is that NCQA has instituted a new naming convention to reduce confusion about the measurement year vs. reporting year. Going forward,…

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CLICK TO VIEW INTERACTIVE VISUALIZATION The implementation of the Affordable Care Act (ACA) significantly changed insurance regulation in the individual and small-group health insurance markets. The ACA included a budget-neutral risk-adjustment program intended to prevent adverse selection by transferring payments to insurers who have higher-risk enrollees as reflected in their claims and supplemental data submitted…

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Note: Since publication, the Public Health Emergency (PHE) has been extended to January 21, 2021. “Unprecedented” is a word you hear frequently these days and for good reason. Never in our lifetimes has the world experienced what is happening right now with the COVID-19 pandemic and its implications. This is especially true when it comes…

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The COVID-19 pandemic of 2020 created an unprecedented time of mass closures…businesses, sporting events, school systems; you name it, it is likely closed. However, the business of healthcare is certainly not closed and nor are the businesses that support every aspect of it, including revenue cycle operations. These operations include risk adjustment, and risk adjustment…

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The 2020 poverty guidelines were released and published in the Federal Register with an effective date of January 14, 2020.   Payers and Providers wait for the release of the poverty guidelines each year to update patient financial assistance and eligibility information within their systems and forms. Controversy has surrounded the poverty guidelines and, more…

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Did you notice that during the current 2020 Open Enrollment Period (OEP), federal and state-based exchanges are publicly displaying their Five-Star Quality System (QRS) rating information on exchange health plans? The goal of the QRS is to increase transparency and competition by providing comparative information for consumers as they shop and select plans. The Centers…

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Fear and confusion have caused immigrants to disenroll from government programs or forgo benefits for which they are eligible. According to a December 2018 nationwide survey, about one in seven adults in immigrant families did not participate in a government program for fear of risking future green card status.1   What is causing this? “Public…

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There is a lot going on with Medicaid these days, but the biggest change may be with Section 1115 Medicaid Demonstration Waivers for work or community engagement. We frequently read or hear the terms “work requirement” and “community engagement” interchanged. For the most part, they are the same type of requirement. A state makes the…

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