Because of a rising number of risk adjustment audits and changes in HEDIS (Healthcare Effectiveness Data and Information Set) rules, providers should prepare for audit volumes to practically double in 2016. In fact, the National Committee for Quality Assurance (NCQA) estimates 2.5 million requests from HEDIS alone and another 6.5 million from health plans in the health information exchange market.
Meanwhile, because of healthcare demand greatly exceeding expectations, losses skyrocketed across the nation for Affordable Care Act exchange health plans. For example, a prominent health plan in the Northeast recently reported an operating loss of $171 million during the first half of this year. Some health plans actually pulling out of the health insurance market completely.
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