Blog
Closure in a Time of Closures: EDPS and RAPS Submissions
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…
Read MoreFederal Poverty Guidelines: 2020 Release and Proposed Changes
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…
Read MoreHealth Insurance Exchange Quality Ratings System
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…
Read MoreIs Your Team Ready for the Public Charge?
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…
Read MoreSection 1115 Medicaid Demonstration Waivers: Redefining Medicaid
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…
Read MoreSection 1332 Waivers: Health Insurance Market Reform
You’ve probably heard of Section 1332 waivers. But do you know what they are or how they may impact organizations, patients or health plan members?
Read MoreSocial Determinants of Health Opportunities: In Practice and In Policy
Social determinants of health (1) as a measurement of a person’s, or a population’s, overall health emerged in the last decades of the 20th century and have now become a recognized metric in US healthcare delivery. In the still-ongoing process of improving the overall access and quality levels in American healthcare, social determinants, or…
Read MoreCMS Best Practices Toolbox Snapshot
This is an overview on how to expand your Risk Adjustment renovation toolbox, so you can better construct and implement your data submission program. The following are the tools and strategies needed to implement the 12 CMS Best Practices and help ensure program success. Tool #1 – Magic Bullet – Analyze transactional reports to track,…
Read MoreSection 1115 Waivers Update – First Quarter 2019
1115 Waiver Activity: 2019 Q1 Overarching Developments There were some key developments in the first quarter of 2019 that have potential long-term impacts to the 1115 waivers: Federal judge blocks community engagement requirements in Kentucky and Arkansas A federal judge’s Mar. 27, ’19 ruling immediately suspended community engagement requirements for Medicaid recipients in Kentucky and…
Read MoreTools to Reduce System and Submission Errors – Best Practice Toolbox for Risk Adjustment Implementation, Part 3
Tools to reduce system and submission errors Part three of a four-part series of CMS Best Practices Implementation Centauri Health Solutions’ Director of Product Strategy – Dawn Carter
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