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Transition to ICD-10 Smooth So Far. What Will an Audit Reveal?

Perhaps due to the multiple delays over the years, the healthcare industry’s switch to the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) on...

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Altegra Health (Virtual) Employee Spotlight: MaryBeth

As accountable care and other value-based payment programs expand across the nation, the demand for care managers has never been greater for both provider and payer organizations. Both types of...

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Three Essential Elements of Provider-Chart Retrieval and Coding Reviews

Provider-chart retrieval and risk-adjustment coding reviews used to be time-consuming, occasionally antagonistic, projects. Providers were suspicious of payer representatives in their practice or...

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Despite ACA-RADV IVA Delay, a Mock Audit is a Smart Move

The U.S. Department of Health and Human Services (HHS) was supposed to send the first Affordable Care Act (ACA) risk adjustment data validation (RADV) audit sample to issuers this summer, but, as often...

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5 Tips to Beat Next Year’s CMS Encounter Data Submission

Next year, the Centers for Medicare and Medicaid Services (CMS) will begin transitioning how it adjusts risk scores for beneficiaries of Medicare, Medicare Advantage, Medicaid and other plans. CMS will...

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Accurately Identifying Risk Requires Better Data and Smarter Math

Despite the vast amount of electronic data available to health plans and providers to determine member or patient risk levels, accurate and timely stratification is actually becoming more complex....

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How Did 2015 Impact Your Revenue Cycle Management?

Just when you thought you had a firm grasp on the revenue cycle operations at your provider organization, 2015 comes along and changes everything. ICD-10, Affordable Care Act (ACA) plans and, perhaps,...

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3 Ways to Help your Star Ratings Shine in 2016

In October, the Centers for Medicare and Medicaid Services (CMS) released its 2016 Star Ratings for Medicare Advantage (MA) plans. The good news is the Star Ratings for plans with prescription drug...

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Will 2016 be the Year of Revenue Cycle Integration?

As electronic health records (EHRs) were implemented nationwide, healthcare provider organizations simultaneously attempted, and continue, to integrate health information systems across their...

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2017 CMS Final Notice – An Executive Response

On April 4, 2016, the CMS Final Notice confirmed a number of changes with significant impact to the market. To understand this impact, we sat down with Kevin Barrett, President Altegra Health and...

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