"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, ...

Healthcare coding has fundamentally transformed from volume-driven revenue capture to compliance-first, defensible documentation standards.

Accurate risk adjustment isn’t just a box to check; it’s now a strategic lever. Hierarchical Condition Category (HCC) coding underpins risk scores that drive Medicare Advantage and other value-based ...

On March 31, 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the finalized capitation rates and payment policies for ...

While technical in nature, risk adjustment is crucial to the future of health care transformation... If reforms to risk adjustment are to succeed, all of us concerned with the future of our health ...

Among other provisions, the Rate Announcement includes the following: Payment Changes/Growth Rates: The effective growth rate for 2024 MA non-End-Stage Renal Disease (ESRD) rates is 2.28%, a slight ...

The Centers for Medicare & Medicaid Services (CMS) recently released its 2026 Medicare Advantage (MA) Rate Announcement, projecting a 5.06% average increase in payments to MA plans — a significant ...

These gradual changes to risk adjustment are a step in the right direction, but there are other ways to get differential coding under control that CMS is not considering implementing. On January 31, ...