Policymakers are exploring reforms to address shortcomings of risk adjustment that inflate Medicare Advantage payments and ...

In the largest Medicare Advantage fraud settlement to date, Oakland, Calif.-based Kaiser Permanente agreed to pay $556 million to resolve allegations it violated the False Claims Act by submitting ...

The proposal would eliminate the financial motivation insurers have to mine their members’ charts for additional diagnoses.

The proposed 2027 Medicare Advantage payment update suggests a minimal 0.09% increase, affecting insurer stock prices and financial outlooks. Proposed Medicare Advantage payment updates spark concern ...

Medicare Advantage is the dominant Medicare delivery system, now covering 54% of all Medicare enrollees. With the increase in enrollment and federal spending, however, has come increased scrutiny from ...

LEWES, Del., April 22, 2025 (GLOBE NEWSWIRE) -- John Snow Labs, the AI for healthcare company, today announced its new end-to-end Hierarchical Condition Category (HCC) coding engine designed to help ...

CMS released its 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, proposing a net average year-over-year payment ...

Joint customers can improve coding accuracy, strengthen compliant submissions, and strengthen RAF integrity with Penguin Ai's HCC Coding & Risk Adjustment Snowflake Native App PALO ALTO, Calif., Jan.

In an individual insurance market, plan payments are risk-adjusted to limit distortions in plan offerings that arise from incentives to select favorable risks. With this objective in mind, risk ...