Achieving Compliance and Accuracy: The Power of Retrospective Risk Adjustment

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.

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

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

As the healthcare landscape evolves, the transition to the CMS-HCC (Hierarchical Condition Category) Model V28 represents a significant shift for

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 Centers for Medicare & Medicaid Services (CMS) recently unveiled a comprehensive CMS proposed rule for the 2025 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

In the ever-evolving landscape of healthcare, health Plans are constantly seeking efficient and reliable solutions to improve their risk adjustment

Healthcare is a complex and rapidly evolving field, and health plans play a crucial role in ensuring that individuals receive

Today, health plans play a pivotal role in ensuring that patients receive the care they need while managing costs efficiently.

In the rapidly evolving landscape of healthcare, where technology is reshaping the way we approach medical treatments, diagnostics, and patient

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

Retrospective chart review (RCR), also known as medical record review is a widely applicable research analysis, methodology, in the healthcare

As per an abstract shared by the National Library of Medicine, a chart review is a methodology to determine a

Risk adjustment medical coding professionals are quite aware of the need for having clear and concise medical records documentation before

In order to determine the health costs of a value-based care patient, Medicare Advantage Organizations (MAOs), Commercial Affordable Care Act

The goal of a retrospective audit solution is to deep-dive into claim data comparison and underline and validate high-risk areas

With value-based care programs¹ being focused by Accountable Care Organizations² (ACOs), which includes a group of doctors and healthcare providers

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

Risk Adjustment for healthcare payers and providers determines the coverage rate for patient care and accurately maps the population’s risk