Risk Adjustment & Coding
Expert articles and analysis related to risk adjustment & coding.
AI Summary — Last 24 Hours
Congressional scrutiny of Medicare Advantage risk adjustment is intensifying, with Sen. Bill Cassidy’s JAMA viewpoint pressing reforms to reduce coding-driven overpayments—directly raising stakes for MA plans, ACOs operating in MA/value-based contracts, and providers reliant on retrospective chart review or coding-intensity workflows (JAMA). At the same time, the provider market is moving toward AI-enabled CDI, coding, and revenue integrity capabilities, illustrated by Sagility’s acquisition of Chirok Health, signaling that health systems are preparing for tighter documentation defensibility and audit exposure under the Trump administration’s CMS/HHS leadership (HIT Consultant). For VBC leaders, the immediate tension is clear: risk capture remains financially critical, but coding unsupported by clinical documentation is becoming a larger compliance, RADV, and contract-performance risk.
Related Articles
Assigned code vs. Note documentation
Assigned code vs. Note documentation  AAPC
Reforming Risk Adjustment in Medicare Advantage—A View From Congress
Reforming Risk Adjustment in Medicare Advantage—A View From Congress  JAMA
M&A: Sagility Acquires Chirok Health to Anchor AI-Driven CDI and Revenue Integrity Across Enterprise Providers
M&A: Sagility Acquires Chirok Health to Anchor AI-Driven CDI and Revenue Integrity Across Enterprise Providers  HIT Consultant
Making Compliant Sense of ICD-10-CM Outpatient Diagnosis Codes – RACmonitor
Making Compliant Sense of ICD-10-CM Outpatient Diagnosis Codes – RACmonitor  MedLearn Publishing