Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: Updates on the efforts of the Academy’s health practice council. its work groups and task forces, to educate health care policymakers on issues including principles for reform, Medicare, the individual insurance market, and risk factors.

Description: The article describes the insurance industry's preparation for pandemic events and the public finance response.

Description: Summary and analysis of the diseases and conditions exhibited in the Medicare Advantage population

Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: This session is about rationing health care. From Record of Society of Actuaries Vol. 18, No. 4A.

Description: Summary of testimony by an AAA Board member before a congressional subcommittee, as an expert on risk assessment and adjustment, especially in relation to Medicare risk contracting and HMO payments. She recommended: mitigating the geographical region values, credibility weights for payments to health plans, carving out high cost claim segments, reengineering the ACR methodology, shifting AAPCC methodology from fee-for-service toward competitive bidding, and further projects to improve risk methods.

Description: This article is about environmental risk occupations, local environment and substance abuse and how they influence actuarial financial estimates. From The Actuary Vol. 24, No. 1

Description: On January 1, 2014, many states will be enrolling newly eligible parents and childless adults into the Medicaid program. This article compares the expansion population to the current Medicaid population.