The Medicare Advantage (MA) risk-adjustment system increases and decreases MA plan payments based on the health risks of their enrollees. The current system assesses health risk based on Hierarchical ...

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 ...

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 ...

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 ...

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 ...

George Witwer, CEO of Cavo Health Outperforms Machine Learning Tools with 96%+ HCC completeness, 2–4x Productivity Gains and Reduced Audit Risk Our platform delivers more accurate, audit-ready results ...

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 ...

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 ...

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.

In fact, a September 2021 report from HHS’ Office of Inspector General highlighted potential concern around Medicare Advantage plan risk adjustment practices. The report found that 20 plans received ...

BELLEVUE, Wash.--(BUSINESS WIRE)--Edifecs, Inc., a global health information technology solutions company, today announced Point of Care Suspects, expanding its comprehensive Risk Adjustment offering ...