In programs with three leading value-based care organizations, including Homeward Health, Zus used AI for both suspecting and recapture to uncover hidden clinical complexity and close risk adjustment ...

Claims data, which form the foundation of risk adjustment in payment for health care services, may reflect efforts to capture more—or more severe—clinical conditions rather than true changes in health ...

George Witwer, CEO of Cavo Health Outperforms Machine Learning Tools with 96%+ HCC completeness, 2–4x Productivity Gains and Reduced Audit Risk Our platform delivers more accurate, audit-ready results ...

"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, ...

Geisinger Health Plan of Pennsylvania has implemented a new application to help professional risk adjustment coders uncover missed Hierarchical Condition Category codes in member charts. The ...

In 2020 Medicare reintroduced Alzheimer’s disease and related dementias (ADRD) Hierarchical Condition Categories (HCCs) to risk-adjust Medicare Advantage and accountable care organization (ACO) ...

Payers stratify premiums for a given benefits package by the member's relationship to the policy holder, and if permitted, by age or gender. This stratification discourages enrolling higher-risk, ...

Risk adjustment for patient experience measures needs to be modified by including the CMS Hierarchical Condition Categories (HCC) risk scores of home health beneficiaries. Conclusions: A negative ...