We appreciate your being a partner inbuilding healthier communities.We hope these resources are helpful.
We view health care as a team effort, with you as our partner in improving the health of our members.Provider Relations is here to make things simpler by being a trusted contact and providing you with:
Feel confident knowing you have a team in your corner, dedicated to finding solutions — working together with you!
Contact Provider Relations at [email protected].
Introducing PCP Assignment — a new tool through Provider Connect for PCPs who have patients that are members of InterCommunity Health Network Coordinated Care Organization (IHN-CCO) and Samaritan Advantage. With PCP Assignment, providers can manage and maintain accurate member assignments, access daily reports and updates in real-time, and track all assignment activities.
Section 12006(a) of the 21st Century Cures Act mandates that states implement Electronic Visit Verification (EVV) for all Medicaid personal care services and home health services that require an in-home visit by a provider. EVV is a Federally mandated requirement for all home health agencies to use an electronic tracking system for time spent with a client.
The Oregon Health Authority has chosen the “Provider Choice Model” which allows providers to select their EVV vendor of choice and self-fund EVV implementation. To be compliant with this requirement, OHA requests that home health agencies report using the approved Electronic Visit Verification template located on OHA’s policy page.
For more information on this requirement, refer to OAR 410-127-0046 (English). Questions should be directed to OHA’s Policy Analyst Shannon Jasper at [email protected].
Take advantage of the following educational resources to help you provide well-rounded care to your patients.
Watch the presentations from our educational Alternative Payment Methodologies Forum in Lebanon.
The following keynote speakers each shared how they have achieved the 5-star designation:
Slides from Sherlyn Dahl
Slides from Megan Van Vleet
Learn how Patient-Centered Primary Care Homes have resulted in better patient health outcomes and lower costs for all Oregonians.
Risk adjustment is defined by healthcare.gov as a statistical process that takes in to account the underlying health issues and health spending of the enrollees in an insurance plan when looking at their health care outcomes or health care costs. In other words, risk adjustment focuses on the accurate capture of a person’s demographics, health conditions and health status, which ensures the health plan receives the compensation it needs to effectively support and keep its members healthy.
The Medicare Advantage risk adjustment process is regulated by the Centers for Medicare & Medicaid Services and uses the Hierarchical Condition Categories (HCCs) risk model to estimate future health care costs. The CMS HCC model includes chronic conditions as well as some serious acute conditions. There are more than 75 HCCs that map to approximately 9,000 ICD-10 codes. These HCCs in addition to demographic factors, like age and gender, make up a person’s risk score, also known as their Risk Adjustment Factor (RAF).
Risk adjustment gives better insight into a person’s health risks and needs. A Medicare Advantage member’s risk score resets with CMS each year on January 1, which is why it’s important to not only see, but also document a person’s risk conditions every year. Accurate documentation leads to accurate risk scores, which results in accurate payments to the health plan. This ultimately allows Samaritan Health Plans to maximize care for its members through various programs and support.
Samaritan Health Plans works closely with providers on its risk adjustment efforts. A couple of those efforts include retrospective chart reviews and ongoing monitoring, which consist of validating medical records throughout the year to ensure accurate payment.
Documenting For Risk Adjustment
COPD – Coding & Documentation
Morbid Obesity – Coding & Documentation
Substance Use Disorders – Coding & Documentation
Medicare Advantage Risk Adjustment | CMS
CMS CSSC Instructional Videos
Justice News | DOJ | Department of Justice
Other questions? Contact Risk Adjustment at [email protected]
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