Risk Adjustment & Attribution
Expert articles and analysis related to risk adjustment & attribution.
AI Summary — Last 7 Days
CMS and HHS are tightening the risk-adjustment perimeter across Medicare Advantage and Marketplace coverage, with the 2027 MA rate process framed as a move to reduce MA plans’ payment advantage and curb coding-driven overpayment while HHS finalizes Marketplace risk-adjustment and standardized-plan changes that affect issuer incentives and benefit design (HFMA, [Health Affairs](https://news.google.com/rss/articles/CBMizAFBVV95cUxOVnctVS1mQl9yX1NqUFFfMmpHRTY2QjFEbWpDd1B2bjdlVHNBUnA2RVRsRHl1STdBaXRGOEtKcGhSWk42NmF1TXlWNWUxQTJ1a0ZJR1FMTDJldkJUSzl4ZmFqZGxwMXZUdVdiS2xST3J1WEQ2Y3Vud082eFZ1OE16UFpCbnI0eFo1N0hCNHBSd1A5M2otX1F2NzhnOF9PZk9vNk5WaDFDM1ZXeHVORlNQQkFjMWR0NjRNME55NXFKYXV5NGZTQVkyN3My
Related Articles
CMS moves to curb MA plans’ unfair payment advantage
In April, CMS published its annual Medicare Advantage (MA) rate announcement for 2027.a For most years in recent memory, this would be a routine event, accompanied by no small amount of headshaking fr...
STAT+: Massachusetts sues UnitedHealth, alleging fraud in state’s Medicaid plans for seniors
State AG alleges UnitedHealthcare claimed some members were sicker to boost its profits.
HHS Finalizes Sweeping Marketplace Changes (Part 4): Standardized Plans, Risk Adjustment, And More
HHS Finalizes Sweeping Marketplace Changes (Part 4): Standardized Plans, Risk Adjustment, And More  Health Affairs
Diagnostic coding misses more than half of long COVID cases: Study
Diagnostic coding misses more than half of long COVID cases: Study  Becker's Hospital Review
From Premiums to Performance: Managing Risk in Self-Funded Health Plans
This brief is the second in a series outlining the fundamentals of self funding. It highlights key steps to successfully establish and manage a self funded health plan, with a focus on funding strateg...
What is risk stratification in healthcare?
What is risk stratification in healthcare?  Aledade
FinancialContent - BeamMed Inc. at the 15th Medicare Stars HEDIS Quality & Risk Forum, Showcasing Portable Bone Density Screening Solutions That Drive HEDIS Measure Compliance
FinancialContent - BeamMed Inc. at the 15th Medicare Stars HEDIS Quality & Risk Forum, Showcasing Portable Bone Density Screening Solutions That Drive HEDIS Measure Compliance  FinancialContent
The ICD-10-CM Code System
The ICD-10-CM Code System  AAPC
DSH hospital system has little money to invest in AI
Candice Powers is chief revenue officer for USA Health, a three-hospital system based in Mobile, Alabama.When it comes to investing in AI in the rev cycle, the relatively small Disproportionate Share ...
Pain Management Coding Trends: What Every Practice Needs to Know Now
Pain Management Coding Trends: What Every Practice Needs to Know Now  AAPC