Managed Healthcare Executive March 15, 2023
With the Centers for Medicare & Medicaid Services extension on claims submissions coming to an end in 2024, health plans must separate fact from fiction around proactive risk adjustment to confidently submit claims for accurate reimbursement.
For many Medicare Advantage and Program of All-Inclusive Care for the Elderly organizations, the Centers for Medicare & Medicaid Services extension on claims submissions reveals just how many lost opportunities there were for capturing more complete, accurate accounts of member conditions.
But with the extension ending, health plans are losing six months for medical record retrieval, reviews, and submissions. A three-month project likely means plans can only retrieve 70% of records versus 90% during a six-month project. This time crunch can affect coding accuracy...
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