Tag Archives: Provide

To Amend Title XVIII of the Social Security ACT to Provide Protections for Medicare Beneficiaries Who Enroll in Medicare Managed Care Plans. (Paperback) – Common

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To amend title XVIII of the Social Security Act to provide protections for Medicare beneficiaries who enroll in Medicare managed care plans. Reviews

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April 23 Webinar Will Provide Analysis, Strategies for the Final CMS 2015 Pay Notice and Call Letter

Washington, DC (PRWEB) April 15, 2014

The final 2015 Medicare Advantage (MA) and Part D pay notice and Call Letter, issued by CMS earlier this month, contains good news but also a host of changes that plans were not expecting. There is a lot of uncertainty, since the impact of many of the changes in the final notice will vary dramatically depending on the particular counties served by the MA plans. On April 23, participants of the Atlantic Information Services webinar, “Final CMS 2015 Pay Notice and Call Letter: Implications and Strategies for MA and Part D,” will learn the implications of CMS’s final 2015 documents and the strategies MA and Part D plans should consider as a result.

William MacBain, senior vice president of strategy at Gorman Health Group, LLC, and Tim Courtney, senior consulting actuary at Wakely Consulting Group, will analyze the final notice and Call Letter, and translate it into steps and strategies organizations should consider for the rapidly approaching bids deadline and beyond. In a lively 60-minute presentation, followed by 30 minutes of responses to individual questions, participants will get reliable answers to questions such as:


What will be the range of the final “all in” 2015 pay change for MA plans? On what will the impact on a particular MA plan depend?
How can MA plans determine the effect of the new reduction in the fee-for-service normalization factor in each of your plan’s service areas?
What will be the impact of CMS’s unprecedented decision to retreat from the phase-in of its new MA risk adjustment system? Why did it do that?
Why did CMS decide to delay its controversial rule limiting the use of home health risk assessments for pay-related diagnosis purposes? What might the agency wind up doing, and when?
How can plans offset declining pay for 2015 if CMS is limiting the maximum increase in Total Beneficiary Cost to less than is permissible for 2014?
How will new restrictions, including possible midyear special enrollment periods, on mass terminations of providers by MA plans affect plan strategies?
What will be the impact of CMS’s decision to delay implementation of the new Part D risk adjustment model?
What information are Part D plans still missing regarding preferred pharmacy cost sharing, and how should they prepare bids until they get it?

Visit http://aishealth.com/marketplace/c4a19_042314 for more details and registration information.

About AIS

Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://www.AISHealth.com.







Dynamic Healthcare Systems Partners with Peak Health Solutions to Provide Comprehensive Risk Adjustment Solutions

Irvine, CA (PRWEB) December 06, 2013

Dynamic Healthcare Systems announced today that they have entered into an agreement with San Diego, CA-based Peak Health Solutions to support compliant outcomes and results for the complex administrative challenges faced by government-regulated health plans. Dynamic Healthcare Systems’ subject matter experts and enterprise software solutions for encounter data processing and risk adjustment complement and will be integrated with Peak’s advanced risk adjustment analytics and medical records retrieval and coding solutions. Together, Dynamic and Peak will provide a comprehensive Edge Server offering for the Commercial Health Insurance Exchange Marketplace as well as solutions for Medicare Advantage plans starting with code capture to risk adjustment to EDPS/RAPS submission.

“Dynamic Healthcare Systems and Peak Health Solutions are working closely together to deliver a complete end-to-end Risk Adjustment solution for government health plans. This business model provides customers the opportunity to work with a consortium of subject matter experts dedicated to solving the complex compliance and administrative challenges of the Medicare and Exchange markets,” said Robert Dunn, President and CEO of Dynamic Healthcare Systems.

“Peak Health Solutions is excited to partner with Dynamic’s solutions to bring a unique full service offering to the Medicare Advantage and Health Insurance Exchange market,” said Gabe Stein, Executive Vice President of Peak Health Solutions. “Dynamic’s enrollment and submission solutions coupled with Peak Health Solutions risk adjustment, quality analytics, consulting and services will allow us to make a quick impact for our clients.”

For more information on the combined Dynamic/Peak solution, visit http://www.dynamichealthsys.com or call 949.333.4565.

About Dynamic Healthcare Systems

Dynamic Healthcare Systems, Inc. delivers comprehensive enterprise software solutions and services for Medicare Advantage health plans, Medicaid, and Exchange markets striving to succeed amid new and evolving regulatory requirements. Headquartered in Irvine, California, the company brings world-class innovations to companies serving the government-regulated healthcare population. For more information, visit http://www.dynamichealthsys.com or call 949.333.4565.

About Peak Health Solutions

Peak Health Solutions’ payer division delivers risk adjustment reporting and quality measurement (Stars) analytics on a single web-accessible decision support software platform. The PeakAnalytics’ software offers a superior set of solutions– capturing and managing data for health plans; transforming the data into actionable information at the plan, provider and member level. Coupled with Peak’s comprehensive chart review and in home assessment capabilities, PeakAnalytics optimizes our clients’ risk scores and can close critical quality care gaps.

For more information, visit http://www.peakhs.com.