Health Care : Current Reviews

Aloke K Mandal

Publications

• Brief Report
  CMS-HCC Risk Score Accuracy Improves Clinical Outcomes among Medicare Advantage Enrollees
  Author(s): Kenneth R Cohen and Aloke K MandalKenneth R Cohen and Aloke K Mandal
  
  The coding of Hierarchical Condition Categories (HCCs) is tantamount for CMS' reimbursing private plans that participate in the Medicare Advantage (MA) program. HCCs are associated with disease states with higher future medical costs. The CMSHCC payment mode provides MA plans with prospective, monthly, risk-adjusted or diseasebased payments centers, based on the concept that recompense should reflect the disease and related cost burdens of the pertinent population. Much has been written about whether HCC coding creates a financial incentive for plans and their contracted providers to exaggerate the disease status of MA enrollees. In this brief report, one independent physician group with over 20 years’ experience in fiduciary risk assumption not only improved its risk scoring processes but also used these scores as an efficacious population health management tool. As demonstrate.. View More»
  DOI: 10.4172/2375-4273.1000205

  Abstract PDF