Risk adjustment

Hierarchical Condition Category (HCC) coding is a risk-adjustment model designed to estimate future healthcare costs for patients.

Read More

Examine how the new Making Care Primary model from CMS aims to integrate primary care, clinical and SDoH data to transform healthcare.

Read More

See why plans need to solve for risk adjustment blind spots using a member-focused retrieval of information.

Read More

Chase lists produced with old methods don't deliver the best outcomes, are inefficient, error prone and results in provider abrasion. See the alternative.

Read More

Risk adjustment is used to appropriately compensate health plans for the costs associated with taking on members with chronic health conditions. See more.

Read More

An HCC is a category of chronic medical conditions that share similar cost patterns. Learn more. Read more HCC FAQs here.

Read More

Risk adjustment programs under the Affordable Care Act, Medicare, Medicaid, and Medicare Advantage evaluate patients’ risk scores based on a combination of condition and demographics data. Using claims, charts, eligibility, and other data, the United States Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) calculate how much to pay insurers based on the health needs of their member population.

Read More

MAOs have six additional months to ensure a complete and accurate data submission. See how to optimize your additional PY2020 Reconciliation Run.

Read More