Tag Archives: Patricia Zenner

Medicare Advantage star ratings: Expectations for new organizations

Successful Medicare Advantage organizations maximize federal revenue to provide enhanced benefits and/or reduced premiums to their members, which ultimately improves marketability with the aim of increasing membership. Organizations entering the Medicare Advantage market should be aware of the current star rating climate as well as short- and long-term star rating and revenue considerations. This report by Milliman consultants provides perspective.

ICD-10 deadline to be pushed back a year?

The U.S. Department of Health and Human Services (HHS) will reportedly announce a proposed extension of the deadline requiring healthcare providers to implement ICD-10, moving it from October 1, 2013, to October 1, 2014. The extension follows an announcement in February that HHS was postponing (actually, “initiating a process to postpone”) the compliance date.

What does this mean for healthcare providers and other organizations with skin in the ICD game? The American Medical Association (AMA) was a major proponent of the postponement and expressed their thanks for it in an official statement:

The American Medical Association appreciates Secretary Sebelius’ swift response to address the AMA’s serious concerns with ICD-10 implementation. The timing of the ICD-10 transition could not be worse for physicians as they are spending significant financial and administrative resources implementing electronic health records in their practices and trying to comply with multiple quality and health information technology programs that include penalties for noncompliance. Burdens on physician practices need to be reduced – not created – as the nation’s health care system undertakes significant payment and delivery reforms.

However, after the delay was announced, two major industry organizations pleaded with HHS to be decisive about the new date—and not to set it too far in the future. Worried about the uncertainty and risk created by a shifting deadline, the College of Healthcare Information Management Executives (CHIME) sent a letter to HHS:

We believe a prolonged delay to ICD-10 implementation, or more specifically, prolonged uncertainty about the timing and details of a delay, will create more problems than it would solve.

Recommendation: We strongly urge HHS to move quickly and decisively in setting a new compliance date for converting to ICD-10. Every day that passes without a concrete deadline is another day that should have been spent planning and implementing this critical undertaking.

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Tick tock

October 1, 2013, sounds like a long way off—unless you are in health IT.

That’s the day that the U.S. Dept. of Health and Human Services (HHS) has set as the deadline for conversion to ICD-10 clinical codes.

Two new Milliman white papers help clarify the issue by looking at critical factors for conversion and by isolating the characteristics that will separate the winners from the losers as the American healthcare system makes this switch.

Anyone looking for even more depth can check back with us for future publications, or join our series of Webinars, which begin tomorrow.