Risk Adjustment โ Second Level Review: HHS-HCC score increased from 3.89 to 4.4 across ACA members
Client Background and Context National Health Plan with 3.5M+ members. The Fortune 500 client found gaps in their coding & claims data collection/submission process for a subset of their ACA…
The Complex Effects of COVID-19 on Risk Adjustment Strategy
Itโs been nearly 25 years since the United States government first began using risk adjustment in the Medicaid program and more than 20 since the country started using it in…
How AI, NLP Technologies Automate Risk Adjustment Processes
Even before the COVID-19 pandemic emerged last year, health care payers were facing numerous challenges. From rising costs and uncertainty about the Affordable Care Act (ACA) to struggles with systems…
Natural Language Processing in Risk Adjustment Coding โ Itโs Not Just for Over-Reads
Risk Adjustment programs are here to stay as we move into a value-based world. With reimbursement for health plans and providers tied to these programs, ensuring they are lean, efficient,…