Payers stratify premiums for a given benefits package by the member's relationship to the policy holder, and if permitted, by age or gender. This stratification discourages enrolling higher-risk, ...

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 ...

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 ...

Policymakers are exploring reforms to address shortcomings of risk adjustment that inflate Medicare Advantage payments and ...

Joint customers can improve coding accuracy, strengthen compliant submissions, and strengthen RAF integrity with Penguin Ai's HCC Coding & Risk Adjustment Snowflake Native App PALO ALTO, Calif., Jan.

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 ...

Claims data, which form the foundation of risk adjustment in payment for health care services, may reflect efforts to capture more—or more severe—clinical conditions rather than true changes in health ...

SAN FRANCISCO, Oct. 8, 2020 /PRNewswire/ -- Innovaccer, Inc., a leading healthcare technology company, has launched its Risk Adjustment Solution. Leveraging Innovaccer's industry-leading, FHIR-enabled ...

The MarketWatch News Department was not involved in the creation of this content. Joint customers can improve coding accuracy, strengthen compliant submissions, and strengthen RAF integrity with ...