Are You Ready for 2016 MA Risk Adjustment?

When you think about 2016, what are the important factors to monitor and drive?

• ICD-10 coding completeness, impact and payments for providers and from CMS

• Encounter Data Systems (EDS)

• Improving insight earlier

• Moving toward a dual-eligibles HCC model in 2017

What analyses should you be running right now before you finalize and implement your strategies for 2016?

• The change in conditions found from ICD-9 to ICD-10? (are estimated risk scores going up or down? Is there a difference in your estimated revenue impact?)

• Do you have the right provider partnerships in place to create timely and complete data?

• Which provider groups need further engagement?

• The RAPS projected RAF vs EDS projected RAF

• Do you have the correct EDS filter logic? Does it impact your RAF score?

• Do you need to refresh your analytics to pull higher yielding charts to navigate around retrieval challenges or non-participating provider groups?

• Do you know how to spend the same money on retrospective strategies for a higher impact on premium accuracy?

• Have you made your 2016 MA calendar from advanced notices, to bids, etc. to ensure your multi-disciplinary team has a coordinated view of the coming months?

• Are you ready in February to analyze your 2015 strategies and impact and enhance them for 2016?

• Are you breaking out your sub-populations for duals vs non-duals, complex, high-risk, etc. to create specific engagement campaigns, care strategies, and coding strategies to ensure they are well managed and have earlier and greater insight in 2016?

In the coming weeks, we will remind you of your important “To Dos”, best practices in risk adjustment management with all the new regulations, conditions, EDS and model impacts and do deep dives into these areas to give your program a foundation of excellence.

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