HCC Under-Coding: The Silent Revenue Leak in Medicare Advantage
When risk adjustment comes up in Medicare Advantage discussions, most attention tends to go toward over-coding. Health plans, provider groups, and coding teams are understandably
Preparing for 2026 RADV Audits: A Payer’s Compliance Checklist
RADV audits are getting more attention across the Medicare Advantage space, and most payers are already feeling the pressure around documentation and coding accuracy. Over
How Prospective Reviews Identify Undiagnosed Chronic Conditions
Chronic conditions don’t always show up clearly at first. Symptoms can be subtle, easy to overlook, or just not documented consistently. In many care settings,
V24 vs V28: A Side-by-Side Comparison for Risk Adjustment Teams
The transition from CMS-HCC V24 to V28 has become a major talking point across Medicare Advantage organizations. Many risk adjustment teams spent years building workflows
Prospective vs. Retrospective Reviews: Building a Year-Round Risk Adjustment Strategy
Risk adjustment plays a critical, often understated role in value-based care. When documentation reflects the true complexity of a patient’s condition, everything downstream, care planning,
How HCC RAF Shapes Real Patient Care
Over the past decade, healthcare reimbursement has steadily shifted away from fee-for-service models toward value-based care, where outcomes and long-term patient health matter more than
Improve Compliance and Financial Performance with a PCP-Centric Risk Adjustment Program
Risk adjustment has become part of everyday operations for organizations participating in value-based contracts. It affects how patient complexity is measured and how reimbursement is
Impact of Accurate HCC Coding on CMS Reimbursements
HCC coding, Hierarchical Condition Category coding, is the methodology used by the Centers for Medicare & Medicaid Services (CMS) to determine reimbursement under Medicare Advantage
Closing the Loop: How Accurate Coding Directly Improves Patient Care Management
When healthcare organizations discuss improving patient care management, the conversation typically centers on care coordination models, value-based strategies, or digital transformation initiatives. All of those