January 29, 2018

HEDIS Reviews: How to Avoid Payer Abrasion

26 minutes

Healthcare Effectiveness Data and Information Set (HEDIS) reviews, underway right now by commercial health plans and government payers, are expected to continue through mid-May. Also expected at that time is a massive number of medical record requests from payers as they seek to improve their Medicare Advantage plan quality measurements, called Star Ratings, which are ultimately published on the Centers for Medicare & Medicaid Services (CMS) website. Explaining the rating systems as well as offering best practices to minimize payer abrasion during this episode of Monitor Mondays is special guest Greg Ford with MRO.

The episode rundown also includes:

Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will file another report on the controversial total knee replacement (TKR) issues that continue to confound physicians and patients.

Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, will have all the latest hot topics and the Monitor Mondays Listener Survey.

Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer will respond to a listener who become ensnared in a Medicare Advantage issue. Spencer is a senior healthcare consultant for DoctorsManagement.

Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will return with another example of a potentially troublesome issue that could pose a risk to your facility.

Prickly Report: Implantable medical device reporting is the prickly subject for the Monitor Mondays Prickly Report. It’s a compliance issue that still confounds providers while at the same time continues to be a hot audit topic for Zone Program Integrity Contractors (ZPICs), Comprehensive Error Rate Testing (CERT), and Medicare Administrative Contractors (MACs). Michael Calahan, vice president of hospital and physician compliance with HealthCare Consulting Solutions (HCS), will explain why this issue is low-hanging fruit for auditors.

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