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Month: January 2021

Jesus Mendoza, Insight and Sales Operations Manager Shares Experiences

This month, we speak to Jesus Mendoza, Insight and Sales Operations Manager about upgrading systems, learning from partners, and his variety of experiences with HealthAxis.

What new implementation are you looking forward to?

I am looking forward to transitioning our current clients that are using our legacy system to the newest version of HxPro technology. I cannot wait to see their reactions to this faster, more efficient experience with additional options and features.

 

The latest version is enhanced with real-time upfront customization and immediate authorization or approvals for providers or members. These features combined with the ability to link providers to multiple locations with varying pay rates will fully automate systems and work cues for a faster overall process.

What have you learned from a client, partner, or coworker that has made an impact on your performance?

A client once said to me, “no matter how hard or difficult the situation becomes, you can choose to react to it positively or negatively.” This is to say that your reaction will influence others to react similarly. They also noted, “choose wisely because you never know who is watching.” I think about this often when approaching a challenge or presenting in a group setting. I know that my reaction to the task or opportunity can be a driving force for our team, and I choose to project positive energy and enthusiasm to all opportunities.

Tell us about your roles within HealthAxis.

I have worn multiple hats being a trainer, researcher, and account manager. As a trainer, I was responsible for coaching new clients on our systems and assisted in providing demonstrations for potential clients. Insights and sales allowed me to research and compare our system to others in the market and offer feedback to our development teams. In my current role as an account manager, I handle everything from tickets and release stories to testing and coordination with production sites for our clients.

CMS Changes to 2021 & 2022 Star Ratings Data Calculations

The Centers for Medicare & Medicaid Services (CMS) announced it will “put patients over paperwork to provide temporary relief from many paperwork, reporting and audit requirements so providers, health care facilities, Medicare Advantage, and Part D plans, and States can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.”

 

 

Summary of  Changes

  • In light of the public safety issues in continuing to require the collection, validation, and submission of data for the 2019 measurement year, the first Interim Final rule removed the requirement for Medicare health plans to submit Healthcare Effectiveness Data and Information Set (HEDIS) 2020 data covering the 2019 measurement year for the Medicare program.

  • CMS is removing the requirement for submission of 2020 Consumer Assessment of Healthcare Providers & Systems (CAPHS) survey data for Medicare health and drug plans. Part C and D plans may use any CAHPS survey data collected for their internal quality improvement efforts.
  • Lastly, the 2020 Health Outcomes Survey administered by NCQA in partnership with CMS as a component of HEDIS data collection is postponed to late summer.

Changes to 2021 Star Ratings Calculations

CMS will also be taking the following actions with respect to 2021 Star Rating calculations:

  • CMS will use last year’s HEDIS measures scores and ratings from the 2020 Star Ratings for the 2021 Star Ratings. 
  • If the COVID-19 outbreak prevents the agency from having validated data or results in systemic data integrity issues for any other measures, CMS will replace the 2019 data that has any quality issues due to COVID-19 with the measure-level Star rating and score from the 2020 Star ratings. 
  • For newer contracts where the 2021 Star Ratings would be the first year that they would receive a Star Rating, CMS will treat them as new for an additional year since CMS would not have enough data to assign a rating.

Changes to 2022 Star Ratings Calculations

For 2022 Star Ratings, CMS expects Medicare Advantage contracts to submit HEDIS data in June of 2021, and Medicare Advantage and Prescription Drug Plan (Part D) contracts to administer the CAHPS survey in 2021.

To address any concerns about overall performance in 2020, the agency is changing the applicability date of the guardrails policy from January 1, 2020, to January 1, 2021. This will delay the implementation of the 5% point cap so that cut points for the 2022 Star Ratings can change by more than 5% points if national performance declines overall as a result of the COVID-19 outbreak.

CMS says it will calculate the Part C and D improvement measure scores for the 2022 Star Ratings as codified, but “recognizes that the COVID-19 outbreak may result in a decline in industry performance, therefore expanding the “hold harmless rule” to include all contracts at the overall and summary rating levels.”

Let HealthAxis’ knowledgeable team and cutting edge services keep your business on track and help you navigate change.