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 ...

Joint customers can improve coding accuracy, strengthen compliant submissions, and strengthen RAF integrity with Penguin Ai's HCC Coding & Risk Adjustment Snowflake Native App PALO ALTO, Calif., Jan.

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.

A growing range of policy discussions correctly assert that the current Centers for Medicare and Medicaid Services’ (CMS) risk-adjustment system needs modernization, reflecting its long history and ...

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 ...

The growth of the Medicare Advantage (MA) program to over half of eligible Medicare beneficiaries has made MA payment a salient part of Medicare policy discussions. Those discussions often focus on ...

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Rate ...

Faced with new government regulations, Medicare Advantage (MA) organizations should be utilizing technology to increase the accuracy of their coding, mitigate their risk, and ensure appropriate care ...

So what can Massachusetts do to address their risk adjustment woes? They are taking a step in the right direction by recognizing that data quality is at the core of any corrective action. Recently, ...

The Alliance of Community Health Plans is calling out risk adjustment scores by larger insurers in Medicare Advantage plans. ACHP, an organization that advocates for smaller health plans, said the ...

While provider and payer groups were happy that the Biden administration delayed implementation of changes to Medicare Advantage’s (MA's) risk adjustment model, they hinted at a sustained campaign to ...