Medicare Advantage (MA) risk adjustment (RA) relies on strong connections between members, providers, and payers, accurate coding, and detailed data submissions. It is a process that continues to evolve to…
As Medicare Advantage (MA) plan options have expanded, the number of insurers wading into MA’s often murky waters is likewise growing. This shift to value-based care from fee-for-service care that…
The financial health of many risk-bearing providers hinges on compliance with risk adjustment and hierarchical condition category (HCC) coding directives associated with Medicare Advantage plans and certain Medicaid plans. Yet…
The pandemic-era risk-adjustment challenges facing healthcare payers and risk-bearing providers are numerous, and they are not limited to the persisting economic impacts of COVID-19. Technology is vital to overcoming current…
Risk adjustment has always been a challenging endeavor, but one essential to fairly compensate payers for taking on patients who are more likely to have high healthcare costs. Government programs,…
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