Review Proposed Changes for Medicare Advantage Plans in 2024 Discuss the change from Version 24 to Version 28 and the impact on Risk Adjustment Calculation Methodology Explain how Fee-for-Service will ...

Medicare Advantage plans and providers need to be aware of the recent increase in government enforcement of risk adjustment coding issues. In the past few years, the Office of the Inspector General ...

Artificial intelligence (AI)-enabled tools such as natural language processing (NLP) have been integrated into a wide range of applications, including risk adjustment coding tools, for greater ...

ECLAT Health Solutions, a leading risk adjustment and coding technology partner for Medicare Advantage, Medicaid and ACA plans, announced agentic AI tools and proprietary Confidence Scoring at RISE ...

In the short run, rather than abandoning disease-based risk adjustment in Medicare Advantage, CMS should address coding intensity issues and continue to move to physician-reported encounter data. In ...

To maximize shared savings, mastering risk adjustment is a critical factor for Accountable Care Organizations (ACOs) participating in MSSP, ACO REACH, and other alternative payment models.

Claims data, which form the foundation of risk adjustment in payment for health care services, may reflect efforts to capture more—or more severe—clinical conditions rather than true changes in health ...

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 ...

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 ...

Since 2010, I've operated at the intersection of healthcare technology, building NLP platforms, collaborating with coders, and diving deep into the mechanics of risk adjustment. The ground beneath the ...

Proprietary Confidence Score and agentic tools improve performance and value for risk-bearing payers HERNDON, Va.--(BUSINESS WIRE)--ECLAT Health Solutions, a leading risk adjustment and coding ...