Health plans complete in-home health assessments (often called health risk assessments) for their members for several reasons: accurately documenting members’ risk burden, supporting...
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Risk adjustment—and the complex nature of the processes involved—is often misunderstood. Learn the fundamentals health plans must master to be successful.
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See the calculatorAs routine medical services are cancelled or postponed due to COVID-19, prospective risk scores used to pay Medicare Advantage (MA) health plans in 2021 are trending lower than...
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Learn best practices to optimizing commercial risk adjustment revenues while maintaining total compliance.
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The public comment period has just closed for the calendar year (CY) 2022 Medicare Advantage (MA) and Part D Advance Notice recently released by the Centers for Medicare & Medicaid...
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Cotiviti's experts break down the >300 changes to the 2021 CPT code set, including a major overhaul to office and other outpatient E&M services.
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This is the story of the birth and evolution of DxCG, one of the earliest and most accurate risk adjustment and predictive modeling solutions in the industry.
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The Centers for Medicare & Medicaid Services (CMS) recently released the health plan-specific 2019 benefit year risk adjustment transfer payments. As part of the Affordable Care Act...
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Ensure compliant, accurate compensation for the risk burden of your members
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Accurately document disease burden and close care gaps
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Effectively identify members with suspected but potentially undocumented conditions
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Ensure member conditions are accurately documented and coded to optimize plan revenues while closing care gaps
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Improve risk adjustment and HEDIS® results while minimizing provider disruption
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Accurately capture and document risk-adjustable conditions
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Improve risk adjustment submission rates
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