NEW YORK, June 1, 2025 (Newswire.com) - As healthcare payers face intensified regulatory oversight, rising healthcare costs, and the evolving complexities of risk adjustment, Black Book Research today ...

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 ...

Risk adjustment requires constant attention to ensure accurate coding, timely regulatory compliance, and streamlined communications across the payer-provider continuum. Increasingly rigorous oversight ...

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 ...

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 ...

In recent years, federal payments to Medicare Advantage plans, and how they are adjusted for enrollee health status, have come under increased scrutiny. Medicare Advantage plans receive a capitated ...

Part 1 below covers key tradeoffs and the first two of four categories of strategies that have been advanced to improve risk adjustment in Medicare Advantage. Part 2 tomorrow will cover the remaining ...

The main difference between MedPAC and CMS estimates of uncorrected coding intensity is that MedPAC’s estimate accounts for the upward trend in coding intensity. The growth of the Medicare Advantage ...