Capturing accurate diagnostic codes through comprehensive risk adjustment programs has become increasingly important for provider-sponsored health plans to improve patient care and clinical quality.
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 ...
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 ...
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 ...
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 ...
Major insurers are gaming Medicare Advantage’s risk adjustment system to reap higher payments from the government, costing Medicare billions of dollars, according to a new analysis of CMS data.
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