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 ...

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 ...

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 ...

Health insurers and stakeholders have expressed support for the Centers for Medicare and Medicaid Services' plan to phase in changes to the risk adjustment model over three years, in the 2024 Medicare ...

As Medicare payment models evolve, reconciling differences in coding intensity between Medicare Advantage (MA) and traditional Medicare (TM) is a persistent challenge. High coding intensity in MA and ...

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Rate ...

Your members are sicker than your risk scores reflect. Not because diagnoses don’t exist—they’re buried under unstructured ...

Talix has entered into a reseller agreement with NextGen Healthcare, Allscripts and Capstone Performance Systems to make Talix’s risk-adjusted coding solution available to customers on the companies’ ...

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.

The Biden administration finalized a proposal to raise Medicare Advantage payments by 3.32% in 2024, slightly above the 1% raise that it proposed. The final payment rule released Friday comes after an ...

Edifecs’ innovation simultaneously improves clinical outcomes, operational efficiency, and financial performance Edifecs, Inc., a global health information technology solutions company, today ...