Risk-adjustment reform should address concerns related to both coding intensity and predictive accuracy. We recommend that reforms to risk adjustment should accomplish key goals including the ...

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

Accurate HCC coding is critical for patient risk adjustment, as it directly impacts reimbursement models and financial sustainability in value-based care.

Inaccurate HCC coding can lead to significant financial implications and variability in Risk Adjustment Factor scores. A new infographic released by PYA illustrates why coding accuracy is ...

"Modifying the HCC model is not a simple technical update or revision," the AMGA says. CMS recently released proposed changes to the CMS-HCC Risk Adjustment Model for payment year 2024 in February ...

The Stakes of HCC Risk Scores Imagine a scenario where a healthcare provider in a bustling metropolitan area is grappling with the complexities of HCC risk adjustment coding. Dr.

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

We will examine how risk was modeled in the Medicare Advantage program and the Affordable Care Act before delving further into the successes and shortcomings of the HCC CMS Risk Adjustment model.