ACHP’s concern is that larger national plans are stifling competition for the smaller insurers. Smaller local plans are ...

A growing range of policy discussions correctly assert that the current Centers for Medicare and Medicaid Services’ (CMS) risk-adjustment system needs modernization, reflecting its long history and ...

Your members are sicker than your risk scores reflect. Not because diagnoses don’t exist—they’re buried under unstructured ...

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 ...

The research from the Alliance for Community Health Plans adds to existing evidence that major insurers are unfairly ...

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 ...

The Biden administration is proposing to increase Medicare Advantage (MA) and Part D plan payments by 1.03% for 2024 amid other changes to the programs’ risk adjustment model. The Centers for 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 ...