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Rachel Katz

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Rachel Katz

Medicare Advantage HEDIS and Risk Reporting: A Primer for Providers

Medicare Advantage (MA) has exploded over the last 10-15 years, with the number of beneficiaries increasing by almost 400 percent in that timeframe. Provider groups have an increasing percentage of revenue and patients in MA plans and providers
are increasingly compensated based on HEDIS quality measures and risk scores through a combination of claims data and supplemental data. Submitting supplemental data can be critical to ensure providers receive credit for the quality of care they deliver and the true complexity of their patient population. Some plans have well-defined reporting programs, while others have little-publicized channels for reporting supplemental HEDIS and risk data. There are also significant bonuses that MA plans offer to providers for reporting, since the plan benefits immensely from receiving the data.
In this article, you’ll learn:

Why is HEDIS and risk data so important to health plans?
What is supplemental data?
And how do you as a provider organization report this data efficiently to earn incentives?

Rachel Katz
Darren O'Brien

A Complete Guide to MIPS Quality Measures

This comprehensive guide includes 12 frequently asked questions about Merit-based Incentive Payment System (MIPS) quality measures. This guide will help increase your understanding of MIPS quality measures so you can choose the best quality measures for your team. Find answers to your questions, including:

Where can I find a list of MIPS quality measures?
What are specialty measure sets and how do they categorize MIPS quality measures?
What are submission methods for MIPS quality measures?
How are benchmarks used to score your performance in MIPS quality measures?
What is the burden of different MIPS quality measures?