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 ...

ECLAT Health Solutions, a leading risk adjustment and coding technology partner for Medicare Advantage, Medicaid and ACA plans, announced agentic AI tools and proprietary Confidence Scoring at RISE ...

Paul D. Jacobs ([email protected]), Agency for Healthcare Research and Quality, Rockville, Maryland. There is widespread agreement that taxpayers pay more when Medicare beneficiaries are enrolled in ...

WALTHAM, Mass.--(BUSINESS WIRE)--Health plans are under greater scrutiny, navigating an increasingly complex regulatory environment. The Centers for Medicare and Medicaid Services (CMS) estimates $4.7 ...

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 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 ...

Jan 12 (Reuters) - Health insurer UnitedHealth Group (UNH.N), opens new tab used aggressive risk-adjustment coding tactics to increase U.S. government reimbursement for patients enrolled in its ...

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 ...

The Centers for Medicare & Medicaid Services (CMS) published its “Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part ...

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.

Proprietary Confidence Score and agentic tools improve performance and value for risk-bearing payers HERNDON, Va.--(BUSINESS WIRE)--ECLAT Health Solutions, a leading risk adjustment and coding ...