Saturday, January 9, 2021

Medicare Risk Adjustment Operations

 


APPROVED by the AAPC for 5 CEUs

Course Overview

Medicare Advantage (MA) is one of the fastest-growing and most complex health plan lines of business representing significant growth opportunities for payers. Launching and/or managing a successful MA market requires careful, strategic planning to meet requirements, ensure compliance, and maximize the program benefits for your organization.

Success in this market will depend on success in each of the following essential areas:

  • Value-based contracting
  • Clinical documentation and coding
  • Delivering high quality care
  • Managing utilization

This course will touch on all four essential areas of MRA Operations.

Learn more or Register here


Review the Agenda below:


Risk Adjustment Operations

  • Medicare Risk Adjustment Overview
  • History of Medicare Risk Adjustment
  • Key Concepts and Terms
  • Risk Adjustment Data
  • Risk Adjustment Process
  • Risk Adjustment Data Validation


CMS-HCC Risk Models

  • PY 2020 CMS HCC Risk Adjustment Model
  • PY 2021 CMS HCC Risk Adjustment Model
  • PY 2022 CMS HCC Risk Adjustment Model


Calculating Risk Scores and Payments

  • General Payment Rules
  • Data Submissions and Payments
  • PY 2020 Risk Score Calculations
  • PY 2020 CMS-HCC Payment Calculation Example
  • PY 2021 Risk Score Calculations
  • PY 2021 CMS-HCC Payment Calculation Example


Optimizing RA Operations

  • Network Adequacy Guidance
  • Medicare Star Ratings
  • Growth and Retention
  • Reports and Resources

Visit www.ERM365.org to see more courses. 



Friday, January 8, 2021

MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline Extended to February 1, 2021



For the 2020 performance year, MIPS eligible clinicians, groups, and virtual groups can submit an application to the Centers for Medicare and Medicaid Services (CMS) asking the agency to re-weight one or more performance categories to 0% due to the COVID-19 public health emergency. This means if you have concerns about the impact of the COVID-19 public health emergency on your performance data – including cost measures – you can submit an application to CMS and cite COVID-19 as the reason for your application.

CMS has recently announced that it will be extending the deadline for COVID-19-related 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception applications to February 1, 2021.

If you have concerns about the effect the COVID-19 public health emergency will have on your performance data for the 2020 performance period, including cost measures,  submit an application now and make sure you cite COVID-19 as the reason for your application. The deadline to submit a MIPS Promoting Interoperability Performance Category Hardship Exception application or an Extreme and Uncontrollable Circumstances application not related to COVID-19 remained December 31, 2020. If you are already exempt from reporting Promoting Interoperability data, you don’t need to apply.

Once you have an approved application, you can still receive scores for the Quality, Improvement Activities and Promoting Interoperability performance categories if you submit data. If the Cost performance category is included in your approved application, you will not be scored on cost measures even if other data are submitted. It is important to note that you cannot submit an application to override data for program year 2020 that has already been submitted and any data submitted either before or after an application has been approved will be scored. 


MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline Extended to February 1, 2021 – Policy & Medicine