A recent review of filings against Medicare Advantage health plans by the federal government makes it clear that Medicare Risk Advantage (MRA) compliance is being poorly managed and supervised by the health plans. And that the government considers it fair game to recoup its prior payments by auditing the documentation that the plans must validate...
One day, my 4-year-old, K, studying in Kindergarten in a reputed school shows her classwork notebook to me and asks very casually and innocently, “Why do I have so many red cross marks and Asmita doesn’t?” A train of thoughts zooms past my head in a fraction of a second. Comparison, performance, peer pressure, self-doubt,...
The value of starting to read at an early age is not a topic for debate. Consistently and across multiple cultures, it has been observed that reading to your child has a beneficial impact on their literacy and cognitive skills, which leads to children reading independently at an early age. Additionally, it makes for a great...
Brigadier Jasbir Singh, SM narrates the many mischiefs during his days at the Rashtriya Indian Military College, Dehradun from 1962 to 1966 in his latest book Once Upon a Time in RIMC. Here’s an exclusive excerpt from the book: After a couple of minutes, we were near Capri Cinema Hall. As we dismounted from the cycles, we could see the front of the hall was well...
What does it mean to be a Rimcollian? Brigadier Jasbir Singh, SM narrates a thrilling account of the happy days at the Rashtriya Indian Military College, Dehradun from 1962 to 1966 in his latest book Once Upon a Time in RIMC. Here’s an exclusive excerpt from the book: As young boys, we were repeatedly told that a healthy body and mind was what everyone expected of us as...
Dr Pariksith Singh’s Sri Aurobindo and The Literary Renaissance of India is a book that commands one’s attention. Attention that is very well deserved. As someone who has been an avid reader invested in works of literature that emerge from the colonies and the non-canon, this piece of writing is a literary wonder that tells us as much about...
Our journey, from the conception of a compliance strategy for our company, to developing a full-fledged culture and integrating it completely with operations might be of some value to others. Let me share a little of what the journey was like. It was circa 2004 that I asked a known professional who had audited charts...
Utilization management (UM), care management, control of spiraling costs, care coordination: these are all the words we hear regularly these days with the advent of accountable care and increased enrollment in managed care plans across the country. But how to manage patient care and optimize costs without withholding care? That is the challenge. To my...
As premiums continue to be reduced, Health Plans, IPAs, MSOs, and medical groups must have plans in place that ensure an accurate RAF score. To obtain these, healthcare organizations must not only recapture the enrollee’s prevalent conditions but compliantly report clinical conditions as they appear. Several organizations have been “playing with numbers” to project future...
