It takes seeing things in a different light to break out of a rut. So, oftentimes when a teacher, a friend, a business partner, a relative, or even a stranger provides that one piece of much needed insight, the proverbial light bulb goes off. It is then possible to finally move forward and start experiencing life in new ways.
During a recent webinar entitled “Expanding Frontiers: The State of Payment Integrity in 2018,” Monique Pierce, Vice President Business Optimization at SCIO Health Analytics, and Leslie Strader, Manager, Product Management at SCIO Health Analytics, discussed how to foster a pragmatic approach to payment integrity. During the presentation, the healthcare executives specifically offered their perspectives on payment integrity trends and challenges; longitudinal data mining; post-payment auditing of outpatient and ancillary claims; the use of medical record reviews in prepayment auditing; and provider behavior modification.
In 2016, there were 32,445 deaths involving prescription opioids, which works out to roughly 89 deaths per day. That’s a 44% increase in deaths in just one year, up from 22,598 in 2015.1 Startling figures, to be sure.
The final Call Letter for Payment Year 2019 has arrived. Health plans not only need to understand all the details of the new Centers for Medicare and Medicaid Service's (CMS) Hierarchical Condition Category (HCC) Risk Adjustment Model outlined within the document but how to deal with these new developments as well.