In risk-adjusted payment models, every detail matters. Each diagnosis a provider documents adds to the overall financial picture. Missing even a single HCC code doesn’t
The U.S. Department of Health and Human Services notes that about 1 in 10 payments to Medicare Advantage groups are inaccurate, usually because some diagnoses
Risk adjustment and revenue cycle management (RCM) appear to be separate functions, with one focusing on clinical accuracy and the other on financial workflow; however,
Accurate Hierarchical Condition Category (HCC) coding remains a major challenge for healthcare organizations. In Fiscal Year 2024, Medicare Advantage recorded a 5.61% improper payment rate,
In healthcare, knowing how complex a patient’s needs are isn’t optional; you miss that, and the consequences can be costly, both financially and clinically. Risk
