On June 30th, CMS announced it was enhancing its Program Integrity efforts that focus on addressing improper Medicaid payments and CMS oversight of state Medicaid programs. The announcement introduced 8 initiatives, including stronger audit functions, enhanced oversight of state contracts…

Traditional revenue cycle management arrangements that focus solely on billing and collections are no longer reliable in the world of delegated risk models, especially for Medicare Advantage (MA) populations. That’s why Pareto recommends an innovative approach to managing value-based payments,…

Health plan revenue is increasingly tied to the concept of risk adjustment. In practice, risk adjustment aligns payments received by health plans with the risk of the populations they manage. Although each market has its own unique version of risk…