Risk Adjustment & Coding
Expert articles and analysis related to risk adjustment & coding.
AI Summary — Last 30 Days
CMS’s latest ACO REACH results sharpen the strategic tension for VBC organizations: the model delivered $988 million in Medicare savings in 2024, but it is still scheduled to sunset at year-end, forcing high-performing participants to plan transitions into MSSP, LEAD, or other accountable care pathways while preserving risk-adjustment, documentation, and care-management infrastructure. At the same time, scrutiny of Medicare Advantage coding intensity is reinforcing a broader payment-accuracy agenda under the Trump administration’s CMS leadership, making compliant diagnosis capture, longitudinal documentation, and defensible RAF performance central to both payer strategy and provider downside-risk readiness. For ACOs weighing LEAD versus MSSP, the near-term decision is becoming less about participation alone and more about capital protection, stop-loss design, and operational coding discipline as CMS finalizes program mechanics and stakeholders push for MSSP changes that improve predictability and participation incentives (ACO REACH savings; MA coding intensity).
Related Articles
Decoding Medicare Advantage Coding Intensity
Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS,...
Highlights From RISKCON 2026
You Can’t Go at It Alone: Transforming HCC Coding Through Partnership, Precision and Purpose
Learn how healthcare organizations are improving documentation accuracy, strengthening risk adjustment performance and reducing coding burden through collaboration and AI-powered support.
Q&A: Designing a connected member journey for risk adjustment programs
Q&A: Designing a connected member journey for risk adjustment programs  Optum Business
External audit of UnitedHealth senior home visits finds most diagnoses supported by medical data
HouseCalls has been accused of generating trumped up diagnoses to hike UnitedHealth’s Medicare reimbursement. But the review found almost 97% of diagnoses found in the home visits were backed up by pa...
KLAS Emerging Company Spotlight: Enhancing risk adjustment coding defensibility through neuro-symbolic AI solutions
KLAS Emerging Company Spotlight: Enhancing risk adjustment coding defensibility through neuro-symbolic AI solutions  Healthcare Dive
KLAS Emerging Company Spotlight: Enhancing risk adjustment coding defensibility through neuro-symbolic AI solutions
See the grades RAAPID's customers gave in the 2026 KLAS Emerging Company Spotlight.
7 Best Risk Adjustment Software Coding Tools for 2026: An Overview
7 Best Risk Adjustment Software Coding Tools for 2026: An Overview  MacSources
7 Best Risk Adjustment Software Platforms for 2026
7 Best Risk Adjustment Software Platforms for 2026Â Â TechBullion
Final 2027 HHS HCC Risk Adjustment Model Impact Estimates
Final 2027 HHS HCC Risk Adjustment Model Impact Estimates  Wakely