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 ...

Accurate risk adjustment isn’t just a box to check; it’s now a strategic lever. Hierarchical Condition Category (HCC) coding underpins risk scores that drive Medicare Advantage and other value-based ...

This interdisciplinary team will be positioned to identify and address concerns and act quickly to implement education and policy updates. Q: We're looking for ways to bring our CDI and coding teams ...

"Modifying the HCC model is not a simple technical update or revision," the AMGA says. CMS recently released proposed changes to the CMS-HCC Risk Adjustment Model for payment year 2024 in February, ...

Two years ago, I would have told you that autonomous AI coding was too risky for risk adjustment. Today, I'm implementing it—but only after finding an approach that met my compliance requirements.

The following is a guest post from Rodrigo Martinez, MD, Senior Vice President, Consulting at Advisory Board Company. As the shift toward value-based care and risk-based contracting progresses, it ...

This is my hands-on evaluation of 10 risk adjustment platforms for value-based care teams preparing for 2026 Medicare ...

Geisinger Health Plan of Pennsylvania has implemented a new application to help professional risk adjustment coders uncover missed Hierarchical Condition Category codes in member charts. The ...

If you thought risk adjustment was a steady drumbeat, 2026 has introduced a new rhythm. CMS has officially completed the phase-in of the CMS-HCC Version 28 model, meaning all Medicare Advantage risk ...