Medicare Advantage plans and providers need to be aware of the recent increase in government enforcement of risk adjustment coding issues. In the past few years, the Office of the Inspector General ...

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 ...

Accurate HCC coding is critical for patient risk adjustment, as it directly impacts reimbursement models and financial sustainability in value-based care. However, studies indicate that as many as ...

Medicare risk adjustment in 2026 is about proving submitted codes, not simply finding more of them. According to CMS’s CY ...

Review Proposed Changes for Medicare Advantage Plans in 2024 Discuss the change from Version 24 to Version 28 and the impact on Risk Adjustment Calculation Methodology Explain how Fee-for-Service will ...

LOUISVILLE, Ky., May 16, 2022 (GLOBE NEWSWIRE) -- The RAAPID risk capture platform is actively taking medical coding to the desired leap of accuracy and profitability with its unique usage of ...

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 ...

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 ...

Risk adjustment could continue to draw on diagnoses from medical claims, but in a more targeted fashion that focuses on diagnoses that supply additional predictive information and are less affected by ...

While technical in nature, risk adjustment is crucial to the future of health care transformation... If reforms to risk adjustment are to succeed, all of us concerned with the future of our health ...

Does AI hold up in retrospective risk adjustment once real customers put it to work? KLAS Research went and asked. RAAPID was featured in the May 2026 KLAS Emerging Company Spotlight, RAAPID AI ...

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.