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Medicare Advantage Hierarchical Condition Categories: Targeting Chart Reviews
Medicare Advantage Hierarchical Condition Categories: Targeting Chart Reviews Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the ...- Authors: Corey Berger, Eric P Goetsch
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Demography; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining; Social Insurance>Medicare; Technology & Applications>Analytics and informatics
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COVID-19, Unknown Unknowns, and Public Finance on the Fly
COVID-19, Unknown Unknowns, and Public Finance on the Fly The article describes the insurance industry's preparation for pandemic events and the public finance response. 5/1/2020 12:00:00 AM ...- Authors: Gregory Fann
- Date: May 2020
- Competency: Technical Skills & Analytical Problem Solving
- Publication Name: In The Public Interest
- Topics: Health & Disability>Health care; Health & Disability>Health risks; Social Insurance; Health & Disability>Affordable Care Act (ACA)
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Government Sponsored Health Actuarial Initiatives in Colombia
Government Sponsored Health Actuarial Initiatives in Colombia Highlights of two 2018 health events organized by the Colombian Association of Actuaries and sponsored by the Colombian Government.- Authors: Armando Zarruk
- Date: Nov 2019
- Competency: Technical Skills & Analytical Problem Solving
- Publication Name: International News
- Topics: Health & Disability>Health risks; Predictive Analytics; Predictive Analytics>Modeling techniques
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The New RBC Formula For Managed Care Organizations
The New RBC Formula For Managed Care Organizations This article is illustrates the implications of the managed care organization MCO risk based capital RBC formula adopted by NAIC and compares it ...- Authors: Steven Wander
- Date: Nov 1997
- Competency: Technical Skills & Analytical Problem Solving
- Publication Name: The Actuary Magazine
- Topics: Health & Disability>Health risks
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Modeling the Unwinding—Where Are We Now?
Modeling the Unwinding—Where Are We Now? Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates ...- Authors: Colby Schaeffer
- Date: May 2024
- Competency: External Forces & Industry Knowledge; Results-Oriented Solutions; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health risks; Health & Disability>Public financing - Health & Disability
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Risk Adjustment: The Details and Why They Matter
Risk Adjustment: The Details and Why They Matter The CMS Risk adjustment model allows actuaries to apply our analytical skills and business knowledge to solve risk and revenue challenges within ...- Authors: Karena Weikel
- Date: Feb 2018
- Competency: Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Health & Disability>Health risks
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Better Care Through Understanding the Customer Not Just the Patient
As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet ...- Authors: James Dolstad, Craig Cartossa, Justin Hartmann
- Date: Dec 2021
- Competency: Results-Oriented Solutions; Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Predictive Analytics; Health & Disability>Provider networks; Health & Disability>Provider risk; Predictive Analytics>Modeling techniques