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Episode 10 - How Coding Validation Benefits Medicare Advantage Plans

Compliance is becoming an increasingly difficult challenge for Medicare Advantage plans, especially when it comes to their risk adjustment programs. When CMS selects plans for a risk adjustment data validation (RADV) audit, they need to have a high degree of certainty that their diagnoses submitted for reimbursement are valid. So, what’s the solution? We look at the benefits of claim coding validation with Lesley Brown, Verscend vice president of Risk Adjustment.


Episode 09 - Navigating to Better Star Ratings Performance

You’ve submitted your final data to NCQA and CMS, marking the end of the HEDIS® 2018 marathon. Now it’s on to the next challenge: Star Ratings performance. In the latest episode of Verscend’s “From the Trenches” podcast, we wrap up this year’s HEDIS season, discuss the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System, and introduce Star Navigator, a new solution to enable Medicare Advantage plans to optimize their Star Ratings.


Episode 08 - The Final Sprint to the HEDIS 2018 Finish

The countdown is on for the June 15 deadline to submit your HEDIS 2018® data, and there’s no shortage of details to keep track of to ensure your submission is accurate, locked on time, and approved by your auditor. We hear from Verscend product manager Jamison Gillitzer and senior data analyst Charan Govind, who offer important reminders to help health plans dot their i’s and cross their t’s in these final weeks of the HEDIS 2018 season.


Episode 07 - Validating Clinical Claims Without Medical Record Review

Automated claim editing systems are a crucial component of accurate and efficient claims payment. But there will always be claims that are too complex to be auto-adjudicated and need a human touch. So, what exactly do you need to clinically validate a claim? We talk with Kris Jensen, registered nurse and clinical consultant for Verscend's Payment Accuracy solutions.


Episode 05 - Are You Catching All Types of Duplicate Claims?

Is your claim editing system catching all types of duplicate claims, or are many of them passing through and getting paid? And if so, what can you do about it? We talk with John Neumann, registered nurse and clinical consultant for Verscend's Payment Accuracy solutions, who breaks down common misconceptions about duplicate claims and describes how health plans can combat them.


Episode 04 - Sifting Through the 2019 Medicare Advantage Final Notice

The Centers for Medicare & Medicaid Services (CMS) has released its final 2019 Medicare Advantage and Part D Rate Announcement and Call Letter. What are the key takeaways for Medicare Advantage plans and their risk adjustment programs? We dive in with Lesley Brown, Verscend vice president of Risk Adjustment, who drives the product strategy for Verscend’s Risk Adjustment solutions.


Episode 03 - HEDIS Measure Changes on the Horizon

In the third episode of our “From the Trenches” podcast, we look at several new measures and measure changes recently proposed by the National Committee for Quality Assurance (NCQA) for next year’s HEDIS® season and how they would impact health plans. NCQA recently held a month-long public comment period for health plans and other stakeholders to weigh in on the proposed changes. Our guests on this episode are Jenna Fitcher, product director for Verscend’s Quality and Performance...


Episode 02 - The Changing Quality Landscape

In our second episode of Verscend’s “From the Trenches” podcast, we discuss a new survey Verscend conducted on the changing quality improvement landscape and what it tells us about how quality measurement and reporting are evolving. As payers increasingly use quality data to drive performance improvement initiatives across their organizations, Verscend conducted the survey in late 2017 to determine how organizational shifts are affecting their strategy and planning.