Category: Cortex Analytics

  • Medicare-Advantage RADV Final Rule Is Out!

    Today, Monday January 30, 2023, CMS issued long overdue regulations governing Risk Adjustment Data Validation (RADV) audits for Medicare-Advantage Organizations (MAOs). https://public-inspection.federalregister.gov/2023-01942.pdf In my opinion, CMS Administrator Chiquita Brooks-Lasure and her lieutenants are one smart set of cookies!  Along with OMB, HHS Secretary Becerra, and of course President Biden.  They have fashioned a compromise regulation that…

  • Make Risk Scores Accurate While Avoiding DOJ

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  • The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions- New York Times

    Federal prosecutors working for the Department of Justice (DOJ) are prosecuting many large Medicare-Advantage Organizations (MAOs) under the False Claims Act. At the same time, auditors at the USDHHS Office of the Inspector General (OIG) have been conducting numerous “cookie-cutter” audits of risk adjustment diagnosis code submission accuracy at many other MAOs. Even though the…

  • Simplifying Medial Claims Subrogation

    Simplifying Medial Claims Subrogation

    cortexsubro is the premier medical claims subrogation management platform designed expressly for government-regulated health plans. cortexsubro is built atop cortexanalytics’ cortexETL, the only Extract, Transform, and Load solution that facilitates user self-service loading of all data files commonly used by Medicare Advantage Organizations, Medicaid Managed Care Organizations, ACOs, and ACA Issuers. cortexsubro’s unique features allows health plan…

  • Risk Adjustment Overpayment Rule Is In Effect

    Risk Adjustment Overpayment Rule Is In Effect

    On June 21st, the U.S. Supreme Court refused to review the D.C. Circuit’s revival of a federal regulation mandating Medicare Advantage Organizations (MAOs) to return excess payments to the government within 60 days to avoid False Claims Act liabilities.  The justices’ decision leaves in place a unanimous Appellate court ruling  that reversed a lower court’s…

  • Your data loss isn’t going to be saved by chart reviews.

    Your data loss isn’t going to be saved by chart reviews.

    Between 3-5% of your entire revenue can be LOST as it passes through external and internal systems as a result of lost data and/or data corruption. Cortex Analytics’ software can help you identify the location and severity of the problem by analyzing the continuity of pre- and post-adjudicated data as your encounters pass from beginning…

  • Join us at the 2021 HLTH Conference in Boston – October 17-20

    Join us at the 2021 HLTH Conference in Boston – October 17-20

    “We believe in the power of community to solve healthcare’s most pressing issues. We do not accept the status quo and challenge other leaders to do the same” – HLTH We are pleased to join HLTH 2021 in Boston as a startup sponsor from October 17-20, 2021.  We will be introducing our Cortex Analytics suite…

  • RISE West 2021: The New World of Data Interoperability: Linking Administrative and Clinical Data

    RISE West 2021: The New World of Data Interoperability: Linking Administrative and Clinical Data
  • Proud Sponsor of the 2021 NCQA & HL7 Digital Quality Summit

    Proud Sponsor of the 2021 NCQA & HL7 Digital Quality Summit

    The Digital Quality Summit 2021 brought together people from different parts of health care to demonstrate techniques for improving the exchange of information critical to assess quality. The goal was to put together the various pieces in order to realize the true potential of digital quality measurement. This event was designed to foster engagement and…