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Jun 9, 2022

Overcoming the Common Challenges of Processing Medical Claims

The CMS 1500 Form, also known as the HCFA form, is an industry-standard form used for medical claims. It is federally regulated and required by Medicare. The general assumption for the CMS 1500 form is that it’s standardized—one form is used by everyone. But in reality, there’s no strict mandate to eliminate the use of older versions. Because of this, many providers continue to utilize older versions of the forms for convenience, each of which has 250+ data fields.

Jun 2, 2022

Changes to the Colorectal Cancer Screening Measure & Transition to ECDS

The Electronic Clinical Data Systems (ECDS) domain of the HEDIS® measurement set has been expanding since NCQA’s introduction of this novel reporting framework in 2015. The use of electronic clinical data for quality measurement facilitates connectivity between payors and providers to improve the efficiency of reporting and to make data available to care teams. For more background on the requirements for ECDS reporting, read our "HEDIS® MY2020 Data Management – Expanding Use of Electronic Clinical Data Systems" blog.

Mar 28, 2022

The Top 9 Benefits of Robotic Process Automation

Organizations are always looking for opportunities to execute faster, cheaper and more accurately, and continue to look to technology for help. Even so, many complex highly regulated businesses in banking, financial services, insurance and healthcare are often inhibited by legacy systems that lack flexibility or an ability to easily integrate, resulting in sustained, costly operations prone to high error rates.

Feb 25, 2022

EBA Proposals Eye Enhanced Credit Spread Risk and Standardized NII

With interest rate hikes now almost a given in the medium-term horizon as a result of increasing inflationary pressure, European regulators are shifting their focus to ensure financial institutions are prepared to weather associated impacts. In December 2021, the European Central Bank (ECB) announced its supervisory priorities for the triennium of 2022-2024 where “Sensitivities and shocks to interest rate and credit spreads” are clearly identified as a key vulnerability for the European banking sector, and therefore, a supervisory priority for the period.

Feb 18, 2022

Physicians Are Finding Opportunities in Value-Based Care

The growing movement towards value-based contracting can cause some hesitancy for physicians, but there are also opportunities for those willing to take on the risk. While value-based care at its core is a push towards focusing on patient outcomes rather than volume of services, physicians are benefiting from a multitude of factors that are a natural part of success in this new value-based environment.

Jan 19, 2022

Addressing Health Disparity: Importance and Impact for HEDIS

Health disparities were among the many challenges brought to the forefront during the COVID-19 pandemic. Recognizing COVID’s impact, the Centers for Disease Control and Prevention published a response outlining strategies to improve the health outcomes of populations disproportionately affected. However, disparities and health equity are not new issues. Mandated by Congress and supported by a U.S. Department of Health and Human Services Interagency Work Group, the Agency for Healthcare Research and Quality (AHRQ) has reported on progress and opportunities for improving healthcare quality and reducing healthcare disparities for the past 17 years. Their 2019 National Healthcare Quality and Disparities Report encompasses reported patient care 2016-2018 and shows there are still disparities when comparing healthcare experience across races.

Sep 21, 2021

Five steps to success through intelligent automation

The new SS&C Intelligent Automation Maturity Model provides a roadmap to companies to fully leverage emerging technologies and to establish the organizational structures to support continual innovation and evolution. The model is built on top of our experience of more than 30 years of providing technology and consulting services to hundreds of customers with a particular emphasis on those in complex, regulated industries, such as financial services, insurance and healthcare.

Aug 26, 2021

RAPS is retiring – are you prepared for the change?

CMS announced this year that Risk Adjustment Factor (RAF) will be entirely calculated through the Encounter Data Processing System (EDPS). This announcement comes ten years after CMS announced its intention to calculate 100% of risk adjustment payments using encounter data and more than six years past the originally planned implementation date. Beginning in 2022, CMS will cease using a blend of encounter and Risk Adjustment Processing System (RAPS) data and move to base 100% of the Risk Adjustment Factor on diagnoses from Medicare Advantage (MA) encounter data and fee-for-service claims. The long runway should lessen the industry impact, but the effects will be largely dependent on how organizations have prepared for the change.


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