Risk Adjustment & Coding
Expert articles and analysis related to risk adjustment & coding.
AI Summary — Last 30 Days
In the past 30 days, the Centers for Medicare and Medicaid Services (CMS) has frozen enrollment in Elevance Health's Medicare Advantage-Part D plans due to noncompliance with risk adjustment and data submission requirements, underscoring a shift towards more stringent enforcement in risk management practices. Meanwhile, a recent analysis indicates that less-efficient Accountable Care Organizations (ACOs) entering the Medicare Shared Savings Program are more likely to earn bonuses, indicating a potential misalignment in incentives that may affect overall cost control and quality of care. Additionally, the implementation of AI-powered tools like CodingGuide by CHRISTUS Health demonstrates a trend toward integrating advanced technology for accurate risk adjustment as healthcare providers navigate the evolving regulatory landscape around risk adjustment policies and compliance requirements, such as those articulated by CMS in recent weeks.
Related Articles
MEAT, TAMPER, PATIO – and the Regulatory Reality of Risk Adjustment
Risk adjustment has entered a new era. We are no longer operating in a documentation optimization environment; we are operating in an enforcement and recalibration environment. For years, clinical doc...
Beyond HCC Alerts: How CHRISTUS Health Achieved Adoption and Accuracy
Partnering with Premier’s Stanson Heath, CHRISTUS Health implemented CodingGuide, an artificial intelligence (AI)-powered, real-time solution designed to help healthcare providers accurately capture a...
Smarter Documentation, Smarter Care: How Tampa General Hospital Overhauled Its Approach to HCC Coding
Tampa General Hospital reimagined its Hierarchical Condition Category (HCC) coding approach with Premier’s Stanson Health CodingGuide, improving documentation accuracy, reducing administrative burden ...
CMS freezes enrollment in Elevance Medicare Advantage-Part D plans
The Centers for Medicare and Medicaid Services is freezing enrollment in Elevance Health’s Medicare Advantage-Prescription Drug Plans for alleged noncompliance with risk adjustment and data submission...
Contributor: REACH Is Delivering Savings—RTA Risk Corridors Put Those Gains at Risk
HIMSSCast: 2026 could be the most challenging year yet for Medicare Advantage payers
This is a difficult time for the Medicare Advantage insurers.MA plans are facing rising medical costs due to increased utilization across a population that is continuing to age and experience chronic ...
Integrating Risk Stratification and Supportive Care in IgA Nephropathy Management
PREVENT Equations Accurately Predict 10-Year CVD Risk Across Diverse Groups
Tending the Embers: Staying Audit-Ready for Medicare RADV
With the January 27, 2026 announcement from The Centers for Medicare & Medicaid Services (CMS)1 regarding the Risk Adjustment Data Validation (RADV) program, it is clear that CMS intends to honor thei...
Wakely Summary: Advance Notice of Methodological Changes for CY 2027 MA Capitation Rates and Part C and Part D Payment Policies
The Centers for Medicare & Medicaid Services (CMS) recently released the 2027 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C/D Payment Policies, which prop...