The Medicare Advantage (MA) risk-adjustment system increases and decreases MA plan payments based on the health risks of their enrollees. The current system assesses health risk based on Hierarchical ...

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 ...

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 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 ...

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 ...

While provider and payer groups were happy that the Biden administration delayed implementation of changes to Medicare Advantage’s (MA's) risk adjustment model, they hinted at a sustained campaign to ...

When Aetna decided last week to drop 70% of its health plans in the Affordable Care Act markets, CEO Mark Bertolini publicly blamed the exits on the poor risk pool, as well as “the current inadequate ...

LOUISVILLE, Ky., Feb. 28, 2025 /PRNewswire/ -- RAAPID, an AI-powered risk adjustment technology leader, will present critical insights on modernizing RADV audit preparation, sharing real-world results ...

Electronic health record (EHR)-based comorbidity assessment had low sensitivity for identifying major comorbidities and poorly predicted survival. EHR-based comorbidity data require validation prior ...

Major insurers are gaming Medicare Advantage’s risk adjustment system to reap higher payments from the government, costing Medicare billions of dollars, according to a new analysis of CMS data.