New York, United States — May 8, 2026 — RAAPID INC launched a unified Risk Adjustment Platform designed to integrate clinical documentation, coding, quality assurance, audit management, and evidence ...
Medicare Advantage is the dominant Medicare delivery system, now covering 54% of all Medicare enrollees. With the increase in enrollment and federal spending, however, has come increased scrutiny from ...
The CMS has provided a long-awaited update on how it plans to approach Medicare Advantage audits, five months after a federal judge threw a wrench in the agency’s plan to drastically expand the money ...
The Centers for Medicare & Medicaid Services (CMS) published its “Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part ...
The Centers for Medicare and Medicaid Services has finalized risk adjustment policies in a final rule to prevent overpayments to Medicare Advantage Organizations. Studies and audits done separately by ...
Increased oversight seems set to focus most intensely on risk-adjustment data validation (RADV), which confirms medical records support diagnoses used for patients. Noting in its recent announcement ...
The Alliance of Community Health Plans (ACHP) is making the case that risk adjustment in Medicare Advantage (MA) needs a significant overhaul. The organization, which represents dozens of ...
Major insurers are gaming Medicare Advantage’s risk adjustment system to reap higher payments from the government, costing Medicare billions of dollars, according to a new analysis of CMS data.
Sen. Chuck Grassley, R-Iowa, chairman of the Senate Committee on the Judiciary, has released a majority staff report that claims UnitedHealth is gaming the Medicare Advantage system and turning risk ...
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