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 ...

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 ...

Artificial intelligence (AI)-enabled tools such as natural language processing (NLP) have been integrated into a wide range of applications, including risk adjustment coding tools, for greater ...

Improving health equity requires changes to risk adjustment, physicians said Tuesday. Current risk adjustment underestimates the total cost of care of patients who have comorbidities and socially ...

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 ...

LOUISVILLE, Ky., June 10, 2026--(BUSINESS WIRE)-- RAAPID, INC., a leading Neuro-Symbolic AI-powered risk adjustment platform for payers and at-risk providers, today announced that it has been featured ...

CMS and policy makers could pursue simple, incremental reforms to reduce overpayment in Medicare Advantage while also paving the way for longer-term solutions to reduce incentives to upcode. To ...

Proprietary Confidence Score and agentic tools improve performance and value for risk-bearing payers HERNDON, Va.--(BUSINESS WIRE)--ECLAT Health Solutions, a leading risk adjustment and coding ...

This is my hands-on evaluation of 10 risk adjustment platforms for value-based care teams preparing for 2026 Medicare Advantage, or MA, and accountable care organization, or ACO, contracts. My scoring ...

Since 2010, I've operated at the intersection of healthcare technology, building NLP platforms, collaborating with coders, and diving deep into the mechanics of risk adjustment. The ground beneath the ...

RAAPID's AI-powered risk adjustment solution received an A+ would-buy-again grade (Emerging Data, n=5) from interviewed customers in the May 2026 KLAS Emerging Company Spotlight, citing AI accuracy ...