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: Budget concerns should not be allowed to override sound actuarial rate development in setting Medicaid capitation rates.

Description: This article describes the Health Insurance Providers Fee implemented through Section 9010 of the Affordable Care Act (ACA) and discusses how the fee will creates challenges in Managed Medicaid Rate development. It also offers some suggested ways to include the fee in Managed Medicaid rates.

Description: Updates on HPC activities, including new work groups for providing input to key players as health care reform moves on from the legislative phase into the regulatory phase, as well as ongoing activities of existing workgroups in financial reporting, long term care, stop loss, disease management, Medicare SUpplement, sovency, cancer claims experience, and risk adjustment.