Category: Risk Adjustment

CMS is expecting 100% of providers to accept downside risk by 2025. Three key opportunities for organizations to assist providers in the transition to value-based care delivery.

Master the complexity of Medicaid state-to-state guidelines with three risk adjustment strategies for success.

Interview at RISE National with U.S Hunger CEO, Rick Whitted, shares his perspective on learning and advancing technology through the pandemic and how to treat people and teams with dignity and trust.

Interview at RISE National with Meyers Group, LLC Senior Partner, J.R. Meyers, shares his perspective on navigating the political environment to generate funding and access for his clients, particularly hospitals and healthcare organizations.

Interview at RISE National with AmeriHealth Caritas risk adjustment leader, Vandna Pandita MPH, shares her perspective on standing out as a female executive of color and championing data integrity to drive better patient outcomes.

Interview at RISE National with Capital Blue Cross risk adjustment leader, Deborah Conboy, shares her perspective on reducing the risk of RADV audits and why risk adjustment professionals should bolster their in-house analytics capabilities.

Interview at RISE National with CareFirst BlueCross BlueShield risk adjustment leader, Biodun Kajopaiye (BK) MHSA, CRC, sharing his perspective on using healthcare as a platform to deliver value and what to look for in a risk adjustment vendor.

As CMS, OIG, and the DOJ increasingly use data analytics to identify instances of fraud, waste, and abuse, health plans must take steps to address compliance issues before they arise.

How can health plans take advantage of the submission deadline extension without putting pressure on already overburdened providers? Read more to find out.

Most health plans only code medical records to 95% accuracy, but in today’s challenging landscape of rising costs and growing compliance risk, this is no longer enough.

With increased audits and crackdowns on inaccurate risk scores, it’s more important than ever to have a comprehensive coding review process in place.

To navigate the transition to value-based care, healthcare organizations need to integrate both prospective and retrospective strategies into their risk-adjustment programs.