Risk Adjustment & Attribution
Expert articles and analysis related to risk adjustment & attribution.
AI Summary — Last 30 Days
CMS is tightening the economics and compliance perimeter around risk adjustment, with the 2027 Medicare Advantage rate announcement aiming to curb MA plans’ payment advantage while DOJ activity and recent settlements reinforce that unsupported HCC capture is becoming a material enterprise risk for payers and delegated-risk providers (HFMA). At the same time, CMMI’s new 10-year LEAD ACO model creates a near-term strategic decision point for organizations willing to manage longitudinal attribution, coding accuracy, and downside-risk readiness ahead of the May 17, 2026 application deadline (Wakely). The through-line for VBC leaders is that risk adjustment is shifting from a revenue-maximization function to a governed infrastructure capability—requiring auditable documentation, AI-enabled but compliance-safe coding workflows, and attribution strategies that can withstand both payment-model volatility and enforcement scrutiny.
Related Articles
Cracking a $50 Billion Problem: How AI Can Make Risk Adjustment More Accurate and More Ethical
Cracking a $50 Billion Problem: How AI Can Make Risk Adjustment More Accurate and More Ethical Pearl Health
AtlantiCare Enhances HCC Coding with Premier’s Stanson Health CodingGuide, Driving Quality and Efficiency
To support its Vision 2030 strategy, AtlantiCare implemented Premier’s Stanson Health CodingGuide to improve the accuracy of Hierarchical Condition Category (HCC) coding, enabling more effective risk ...
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...
Justice Department can question former Elevance exec in Medicare Advantage fraud case, judge rules
Closing the revenue gap: How health plans can boost RAF scores through smarter coding and data strategies
Closing the revenue gap: How health plans can boost RAF scores through smarter coding and data strategies DOTmed
Google News
Navina - AI Tool for Capturing HCC Gaps AAPC
The 8 Best Risk Adjustment Coding Software Platforms: A Compliance Leader's Honest Review
The 8 Best Risk Adjustment Coding Software Platforms: A Compliance Leader's Honest Review Impakter
RAAPID INC Launches Unified Risk Adjustment Platform to Support Medicare Advantage Audit Readiness and Clinical Documentation Integrity
RAAPID INC Launches Unified Risk Adjustment Platform to Support Medicare Advantage Audit Readiness and Clinical Documentation Integrity USA Today
Report: UnitedHealth Group used 'aggressive tactics' in Medicare Advantage risk assessments
Report: UnitedHealth Group used 'aggressive tactics' in Medicare Advantage risk assessments MSN
Alignment CEO expects short delay for CMS' proposed risk adjustment changes
Alignment CEO expects short delay for CMS' proposed risk adjustment changes Fierce Healthcare