Las Vegas became the stage for a clear message at RISE West 2025: Medicare Advantage is entering an era of universal oversight. For risk adjustment leaders, the conference was not […]
From Risk to Readiness: How MA Plans Can Survive and Thrive in the New RADV Era
CMS just rewrote the rules for Medicare Advantage. Every plan, every year, will face RADV audits. Fear costs money. Readiness protects it. Here’s how to prepare.
CMS Just Changed the RADV Game: Every MA Plan, Every Year
CMS just rewrote the RADV playbook. Every Medicare Advantage plan will now face annual audits with full extrapolation. The stakes are higher, and the only defense is readiness.
Decoding RADV Audits: A Comprehensive Guide for Health Plans in 2025
Home The landscape of Risk Adjustment Data Validation (RADV) audits is shifting rapidly. With CMS doubling the number of audits and eliminating past leniencies, health plans must be proactive, not […]
CMS-HCC V28 Overview: What Medicare Advantage Plans Need to Know
Home The Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCC) model plays a crucial role in risk adjustment for Medicare Advantage (MA) and other health plans. CMS […]
How to Succeed in ACO Implementation: Essential Strategies and Insights
Home Accountable Care Organizations (ACOs) are at the forefront of healthcare’s shift toward value-based care, aiming to enhance patient outcomes while effectively managing costs. To achieve these ambitious goals, ACOs […]
Optimizing Clinical Operations in ACOs: Strategies for Value-Based Care Success
Home As the healthcare industry transitions more towards value-based care, optimizing clinical operations within Accountable Care Organizations (ACOs) has become essential for achieving sustainable success. With a focus on process […]