In part one of this four-part series, we reviewed what is changing with the American Medical…
Category: News
Risk adjustment audit readiness instills clinical discipline
Every diagnosis a Medicare Advantage plan submits to the Centers for Medicare & Medicaid Services (CMS)…
Webinar: Decoding the 2027 Star Ratings
The 2027 Star Ratings results released by CMS earlier this month send a clear message to…
Payer Policy Pulse: October 2026
Payers are navigating a steady stream of new rules, enforcement actions, and market shifts. Payer Policy…
Maternity Care Coding 2027: What is changing
The American Medical Association (AMA) is dismantling the global maternity coding model. For more than three…
Cultivating a strategic advantage during Medicare enrollment shifts
Medicare Advantage (MA) continues to grow, but the market dynamics behind that growth are changing. As…
What CMS’s evolving risk adjustment strategy means for health plans
Medicare risk adjustment is approaching a turning point. In recent years, the Centers for Medicare &…
Bridging the divide between fax and FHIR
The healthcare industry is making significant progress on electronic prior authorization. Standards are maturing, federal requirements…
Next in risk adjustment: Auto-linking charts to encounters
In April 2026, the Centers for Medicare & Medicaid Services (CMS) announced excluding diagnosis codes from…
Preparing for what’s next: Risk adjustment strategies for 2027 and beyond
In Q4, Medicare Advantage risk adjustment leaders are balancing two critical priorities: closing out the current…