Risk Adjustment & Coding
Expert articles and analysis related to risk adjustment & coding.
AI Summary — Last 30 Days
Risk adjustment and coding are becoming central to ACO strategy as CMS weighs MSSP changes and the LEAD Model while ACO REACH—set to sunset at year-end—reported $988 million in 2024 Medicare savings, strengthening the case for advanced accountable care models but intensifying scrutiny over benchmark accuracy, documentation integrity, and coding-driven performance variation. Organizations accepted into LEAD now face near-term portfolio decisions between LEAD and MSSP, with participant TIN lists due in early August and financial methodology still pending, making risk mitigation, stop-loss design, and coding governance critical before taking downside risk. At the same time, Medicare Advantage coding intensity remains under pressure, reinforcing a broader Trump administration CMS agenda around payment accuracy that will affect how ACOs, MA plans, and provider groups invest in clinical documentation, data infrastructure, and compliant population risk capture (ACO REACH savings; MA coding intensity).
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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...
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