Two Key Changes to the CMS-HCC 2020 Model

The Center for Medicare & Medicaid Services (CMS) contracts with Medicare Advantage Organizations (MAOs) and pays Medicare Advantage (MA) plans for managed health care based on a monthly fee per member. The payment is based on the future health care needs and the sickness burden of its members. MA is an alternative to the traditional fee-for-service Medicare.

Accuracy, Data and Integration – Success in Risk Adjustment & Quality

The Center for Medicare & Medicaid Services (CMS) contracts with Medicare Advantage Organizations (MAOs) and pays Medicare Advantage (MA) plans for managed health care based on a monthly fee per member. The payment is based on the future health care needs and the sickness burden of its members. MA is an alternative to the traditional fee-for-service Medicare.

Minimize Compliance Risk: qrcAnalytics Assists Medicare Advantage Organizations

The Center for Medicare & Medicaid Services (CMS) contracts with Medicare Advantage Organizations (MAOs) and pays Medicare Advantage (MA) plans for managed health care based on a monthly fee per member. The payment is based on the future health care needs and the sickness burden of its members. MA is an alternative to the traditional fee-for-service Medicare.

Pathways to Success: For ACOs, a key to managing two-sided risk is to understand the patient risk adjustment score

On December 18, 2018, CMS issued a final rule that creates a new direction for the MSSP Program, generally referred to as the “Pathways to Success” — which is the government’s dramatic redesign of Accountable Care Organization (ACO) Programs. The rule is complex, but the basic change is simple:

Bringing clarity to the complexity of simultaneously managing quality, risk, and cost.

Every month, qrcAnalytics moves 5 million lives through our qrcEngine™. We process data quickly and accurately, supplying actionable insights for C-suites and providing clinical data sweeps that generate reports to focus the work of auditors and clinicians.

Tracking Quality, Risk and Cost: Three Things that Harm Value-based Payments

The Affordable Care Act in 2010 made a large shift from fee for service to fee for value (or pay for performance) and the trend has been increasing in recent years.