Medicare Advantage plans and providers need to be aware of the recent increase in government enforcement of risk adjustment coding issues. In the past few years, the Office of the Inspector General ...

The Medicare Shared Savings Program (MSSP) adjusts savings benchmarks by beneficiaries’ baseline risk scores. To discourage increased coding intensity, the benchmark is not adjusted upward if ...

Medicare open enrollment kicked off Friday with more Medicare Advantage plans to choose from but with renewed criticism that insurers are gaming risk adjustment practices to inflate profits. While ...

Claims data, which form the foundation of risk adjustment in payment for health care services, may reflect efforts to capture more—or more severe—clinical conditions rather than true changes in health ...

Geisinger Health Plan in Danville, Pa., implemented automated coding technology from Talix to streamline risk adjustment processes. The application, Coding InSight, is designed to help professional ...

Review Proposed Changes for Medicare Advantage Plans in 2024 Discuss the change from Version 24 to Version 28 and the impact on Risk Adjustment Calculation Methodology Explain how Fee-for-Service will ...

To maximize shared savings, mastering risk adjustment is a critical factor for Accountable Care Organizations (ACOs) participating in MSSP, ACO REACH, and other alternative payment models.

RAAPID INC launched a unified Risk Adjustment Platform designed to integrate clinical documentation, coding, quality assurance, audit management, and evidence trails into a single system intended to ...

LEWES, Del., April 22, 2025 (GLOBE NEWSWIRE) -- John Snow Labs, the AI for healthcare company, today announced its new end-to-end Hierarchical Condition Category (HCC) coding engine designed to help ...

NEW YORK--(BUSINESS WIRE)--Datavant, the data collaboration platform trusted for healthcare, today announced that it has been named the #1 Ranked 2026 Best in KLAS Award winner in both the Risk ...