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What Will COVID-19 Mean for STARS and Risk Adjustment Reporting?

One thing is for certain: The world has fundamentally changed.

I’ve seen it said that the changes that we are seeing across the globe were inevitable, and that the novel coronavirus has basically been a catalyst that has accelerated the process.

What kinds of changes are we already seeing and will continue to see when it comes to healthcare, and especially Medicare? I’m going to be laying out some of my “predictions” over the next few weeks. But before we get into the long term structural changes, let’s talk about an immediate one.

One Heck of a 2020 Reporting Season

We’re already hearing from clients and contacts in the industry that in many markets documentation submissions and record retrieval have nearly shut down. As one fellow put it, “we’re still receiving some, but all the pressure has been taken off providers for now.”

This of course makes sense when in many areas practices were partially or completely closed down, and there wasn’t any staff available to submit Ms. Smith’s mammography from 3 months ago. But what is that going to mean in 4 months when we are in the throes of reporting for STARS and Risk Adjustment?

Is CMS going to offer extensions? They’ve been flexible with other requirements in the midst of this, but will they expect things to be “back to normal” by January of next year? Certainly, health plans receiving a backlog of records from the entire year in November or December is nothing new, but will it be worse this year?

Health Plans that have long lag times in documentation review and feedback reporting are going to have to find a way to accelerate that process. Not only just to get the records in, but to give their providers opportunities for resubmissions as well.

We’ve found in our clients that often 25% of the initial record submissions from providers are incompliant in some way. By speeding up their review and feedback process, health plans can provide the education necessary and PCPs can resubmit. That has a huge impact on overall compliant submission rates.

I see several more changes coming, and as mentioned, I’ll be discussing more of these in next few weeks. No matter what the future holds, however, we do know that populations will continue to age, and there will always be a need for healthcare. But how we administer healthcare will change drastically. There is no other option. We’re happy to be a part of that transition.

-John

Photo by CDC