Wouldn’t you know?
The day I put the finishing touches on my wildly popular “Success Codes” series, CMS upped the ante by tweaking the risk-coding system for 2019 and beyond in a significant way.
But it’s ok, I’ve been through this before.
In the early 2000s, CMS announced it was transitioning Medicare Advantage from a demographic-based to a disease-burden based payment system over a five-year period.
My practice caught wind of this early on—more than a year before the transition began.
We hit the ground running with clinician education, chart reviews, and internal auditing workflows.
The result?
By the time risk-based payments were fully in effect, we were firing on all cylinders while almost everybody else was struggling to catch up.
Our financial performance was astonishing.
At the end of this past December, CMS released “Part 1” of its 2019 advance notice of changes to MA capitation rates and Part D payment policies.
These changes represent CMS’ response to the statutory language in the 21st Century Cures Act, passed last year. The new model will not be nearly as impactful as the full transitioning from demographics to disease burden that I went through, but it will make a significant difference.
And over the next few Mondays, we’ll be discussing the specific changes and the adjustments you can make to do even better than you are right now.
But if you want to excel, really excel at your corporate or individual financial performance, there is one concept you must take to heart.
Those that get there first will do the best.
Bigly!
This is not my opinion or a simple observation. This is hard fact borne out through tough but satisfying personal experience in previous Medicare Advantage payment transitions.
Even though these risk-coding changes are phasing in over three years, don’t let institutional inertia result in sitting back and letting them come to you, you bring your systems to them—now.
Certainly there will be costs associated with making the adjustments to your systems before you “have to.”
Costs for education, compliance, and new workflows.
But you’re going to have to do them eventually.
And you’ll get the most out of your investment if you act like the new model is going into full effect right now.
In doing so, you’ll find your risk-based revenue will increase while everyone else is struggling to catch-up
Individuals and organizations pay me five to six figures for advice like this.
I’m giving it to you for free.
So get started now.
Educate yourself and start coding like the full “go-live” date was today.
In three years time, you’ll be mighty glad you did.
Executive, administrator or clinician; here are even more specific, actionable tactics for Medicare Advantage Success. Strategic thoughts and tactical pearls are posted every Monday and Thursday, sign up for delivery to your inbox and never miss a single one!
Last week’s high-value tactic.
Stay ahead of the managed care curve with topical weekly intelligence and immediately useful insights—and receive a value-packed free white-paper tailored specifically to your circumstance–subscribe to Value-Based Transformations today!
You can catch unique, high-value content including live-streams on my Professional Facebook page.
Collaborate with us through LinkedIn.
Interact with us via Twitter.
Like my Facebook Page.
Catch valuable videos and live-streams on my YouTube channel.
Want a high-value jumpstart? Just published with the latest information, tools, and tactics, Medicare Advantage Mastery will set you on your way with your first 12 steps to excellent managed care performance.