Implement these key steps to optimize your risk adjustment strategy during COVID
In an unexpected but certainly welcome announcement, CMS has extended the 2020 payment submission deadline for six months beyond the original January 31, 2021 cutoff date. Acknowledging the difficulties health plans have experienced in retrieving patient charts from providers during the COVID-19 pandemic, CMS now will accept submissions through August 2, 2021.
Payers still face major hurdles in 2021, with risk adjustment revenues expected to drop at least 5%. Handled strategically, however, the extension provides plans the opportunity to alleviate these challenges. The key to offsetting lower 2021 revenues is for plans to use the extra time wisely and start focusing on these three tactics:
- Conduct second-level reviews on charts you have already retrieved, reviewed, coded, and submitted to CMS. Reviewing previously coded charts from 2019 encounters can subject them to additional analytics that may uncover HCC gaps that can be resubmitted for reimbursement.
- Continue to chase charts from providers. One of the main motivations behind CMS’s extension is to give extra time for health plans to track down charts that could not be retrieved owing to pressures on providers’ resources.
- Expand your suspecting logic to identify additional members whose treatment encounters could be re-coded to include CMS risk-adjustment measures. However, beware of the law of diminishing returns and only chase chart models and categories that promise positive returns on the time and resource investment.
Watch a short 3-minute video on how health plans can use this opportunity to salvage a big slice of their 2021 revenues.
Director of Risk Adjustment Solutions
Peter Janelle has more than a decade of experience in health insurance, having worked both for payers and vendors. He has extensive knowledge of Medicare Advantage finance, including risk adjustment, stars, value-based arrangements, and healthcare economics. Before joining Vital Data Technology, Peter was in charge of risk adjustment operations at UCare, a regional Minnesota insurer with books of business in Medicaid, Medicare Advantage, and ACA.
His entrepreneurial approach to product development has been shaped both by this healthcare experience and by his leadership of The Liquor Cabinet, a digital content brand with an iPhone app and a comfortable social media following. In addition to traveling the globe in search of unique liquors, Peter enjoys photography and outdoor adventure. An annual highlight is his annual winter camping trip to northern Minnesota.
Peter holds a Master of Public Policy 0from the Humphrey School of Public Affairs at the University of Minnesota.