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 ...

Medicare Advantage is the dominant Medicare delivery system, now covering 54% of all Medicare enrollees. With the increase in enrollment and federal spending, however, has come increased scrutiny from ...

Joint customers can improve coding accuracy, strengthen compliant submissions, and strengthen RAF integrity with Penguin Ai's HCC Coding & Risk Adjustment Snowflake Native App PALO ALTO, Calif., Jan.

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.

(WHTM) — Health insurance company Aetna has agreed to pay over $117 million to Pennylvanians to resolve allegations that it violated the False Claims Act for profit, the Department of Justice said.

The Biden administration is proposing to increase Medicare Advantage (MA) and Part D plan payments by 1.03% for 2024 amid other changes to the programs’ risk adjustment model. The Centers for Medicare ...

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 ...

Datavant, the data collaboration platform trusted for healthcare, today announced that it has been named the #1 Ranked 2026 Best in KLAS Award winner in both the Risk Adjustment: Coding, Retrieval & ...

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 ...

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 ...