Inovalon Insights

by "Inovalon" on 11/10/2014 11:11 AM

For ACOs preparing for the upcoming GPRO season in January, now is the time to ensure you have covered all your bases for the following key components: staffing, record collection, data abstraction, tracking and reporting, as well as audit readiness.

Staffing can be challenging for ACOs during GPRO season. It is important to plan ahead and determine whether it is possible to create capacities for medical staff members to execute the medical record reviews without their regular workload suffering—or whether it would be better to outsource this task to a vendor. Choosing the most efficient process, while ensuring quality outcomes, is the first key decision for an ACO.

by "Inovalon" on 10/27/2014 12:45 PM

Inovalon is pleased to announce that it has been approved by CMS as a third party administrator (TPA) for EDGE server data submission. The deadline for issuers or TPAs to submit data onto the CMS EDGE Server is fast approaching: December 5, 2014.

In addition to writing new or updating existing code necessary for submission, it is recommended that issuers and TPAs also use the remaining weeks before the deadline to undertake important tasks that can help facilitate the process, including the following:

  • Analyze recent CMS updates
  • Investigate numerous scenarios
  • Adapt code to include changes and use cases
  • Integrate code against underlying data

The final step is to release the code into production. Along with writing good software, it is essential for organizations also to have complete and accurate data in place, ensuring appropriate quality assurance and testing.

by "Inovalon" on 8/27/2014 10:47 AM

As summer comes to an end, insurers need to think seriously about December. The first estimate calculations from CMS will come in the middle of December, but only for those who register in September or early October and quickly begin setting up their servers and testing data submissions.

Fortunately, CMS’s recent release of its EDGE server implementation timeline means we can clearly see all the tasks involved and the deadlines to hit.

by "Inovalon" on 8/20/2014 12:21 PM

It seems counterintuitive, but in healthcare, it’s often the things you can’t see that are most important. Providers and payers need to see the patient and the patient’s medical records, of course, but finding where care is missing is perhaps the most critical and challenging issue these days.

Care improvement experts from the government and elsewhere have endorsed the idea of care gaps being addressed using a medical record review (MRR) process in which medical data is retrieved from providers’ electronic  health records (EHRs). The data retrieved from EHRs can then be used to

by "Inovalon" on 7/7/2014 11:59 AM

In June, the Centers for Medicare & Medicaid Services (CMS) threw another twist into the already complicated EDGE server game. On June 4, CNBC reported that insurers selling Affordable Care Act (ACA) plans are allowed to use Amazon’s Web Services cloud to host the de-identified data they’re required to share with CMS.

For some plans, this is excellent news. In a recent conference call, CMS said the Amazon option will cost between $6,000 and $24,000 per year for the service, depending on plan size. This contrasts with the cost to purchase an EDGE server, which can run from $10,000 for small plans up to $50,000 for large plans, not including maintenance costs.