The Medicare Advantage (MA) risk-adjustment system increases and decreases MA plan payments based on the health risks of their enrollees. The current system assesses health risk based on Hierarchical ...

UnitedHealth Group is facing a torrent of accusations that it and its industry peers have exploited the Medicare Advantage ...

Faced with new government regulations, Medicare Advantage (MA) organizations should be utilizing technology to increase the accuracy of their coding, mitigate their risk, and ensure appropriate care ...

Geisinger Health Plan in Danville, Pa., implemented automated coding technology from Talix to streamline risk adjustment processes. The application, Coding InSight, is designed to help professional ...

As Medicare payment models evolve, reconciling differences in coding intensity between Medicare Advantage (MA) and traditional Medicare (TM) is a persistent challenge. High coding intensity in MA and ...

Health insurers and stakeholders have expressed support for the Centers for Medicare and Medicaid Services' plan to phase in changes to the risk adjustment model over three years, in the 2024 Medicare ...

George Witwer, CEO of Cavo Health Outperforms Machine Learning Tools with 96%+ HCC completeness, 2–4x Productivity Gains and Reduced Audit Risk Our platform delivers more accurate, audit-ready results ...

Talix has entered into a reseller agreement with NextGen Healthcare, Allscripts and Capstone Performance Systems to make Talix’s risk-adjusted coding solution available to customers on the companies’ ...

A leading Managed Care Analyst at Baird, Michael Ha, has a warning against UnitedHealth Group Inc.'s prized Optum Health ...

LOUISVILLE, Ky., Feb. 28, 2025 /PRNewswire/ -- RAAPID, an AI-powered risk adjustment technology leader, will present critical insights on modernizing RADV audit preparation, sharing real-world results ...