Prospective vs Retrospective Risk Adjustment: Building an Effective ROI & Compliance Framework

Medicare Advantage Organizations face unprecedented challenges as CMS accelerates RADV audits across the industry. With contract-level extrapolation now in effect

In the intricate world of value-based care, where precision and accuracy can make all the difference, one critical aspect often

As CMS finalizes the 2026 payment policy updates for Medicare Advantage and Part D programs, the shift toward using MA

The Centers for Medicare & Medicaid Services (CMS) has laid the groundwork for a transformative shift in Medicare Advantage (MA)

Evolution of Forward-Thinking Health Plans The evolution of forward-thinking health plans serves as a profound reminder of how modern value-based

Healthcare Plans are in constant flux, making it vital for Medicare Advantage Organizations (MAOs) and medical groups to keep their

Are you ready for major changes impacting your healthcare costs in 2025? Even though it’s several months off, Medicare is

In the ever-evolving Medicare Advantage risk adjustment landscape, understanding the shifts and developments is crucial for staying competitive and effective.

How CMS Star Ratings are assessed The Centers for Medicare & Medicaid Services releases its quality Star Ratings each October

Between 2024 and 2025, payments to Medicare Advantage plans are anticipated to increase by an average of 3.70 percent, amounting

Introduction The Hierarchical Condition Category (HCC) risk adjustment model, initially introduced by CMS in 2004, serves as a pivotal method

CMS UNVEILS THE PROPOSED FINAL RULE FOR MEDICARE ADVANTAGE IMPACTING HEALTH PLANS, PROVIDERS & PATIENTS. The 724-page final rule was

The release of the 2024 Medicare Advantage Star Ratings marks a critical juncture for health plans participating in Medicare Advantage

The Medicare Risk Adjustment landscape is a complex one, with health plans constantly striving to ensure accuracy in their HCC

In the complex healthcare landscape, where regulatory oversight is rigorous and financial risks loom large, health plans face an increasingly

Healthcare fraud and misuse is a federal offense and negatively impacts care delivery on the whole. It impacts healthcare costs

With the modern technology inclusion in the health care ecosystem, payers will have to be coerced to adapt with many

A survey conducted to understand the healthcare payer market size, shares, trends, and analysis stated that the global payer healthcare

A Study by the National Library of Medicine¹ has stated that several types of Artificial Intelligence (AI) are being adopted by