The healthcare industry is already using shopping habits and financial records for predictive analysis. Now some are turning toward social media data and other public records, raising concern that practices will be overly intrusive and conducted without patients even knowing.
Medicare Advantage (MA) plans are private health plans that have contracted with Medicare to receive a fixed monthly fee in exchange for providing comprehensive healthcare to plan members. In order to provide appropriate care to beneficiaries with varying medical conditions, plans are paid according to the Risk Adjustment Factor (RAF) score of each patient. Insufficient documentation of chronic conditions can be an obstacle to MA reimbursement. However, even when a condition has been properly documented by the provider, it is often not coded and submitted to Medicare. Read this white paper to learn how to take the complexity out of MA reimbursement.
Median numbers, important though they may be, tell only part of the story – and a slightly skewed one at that. Unless hospitals also gather statistics on the averages for each of these measures, they're probably seeing a rosier picture of their operations.