Revenue cycle leaders face increasing pressure to manage costs, optimize revenue, and improve revenue cycle functions. This has included more responsibility in understanding the intersection between risk adjustment coding and social determinants of health (SDOH). This intersection is critical to ensuring accurate reimbursement and optimizing revenue cycle outcomes, especially for Medicare Advantage and Medicaid populations, where SDOH significantly influences health outcomes and
Understanding Hierarchical Condition Category (HCC) coding should be a priority for any revenue cycle leader. This is because risk adjustment coding is critical to estimating costs
Retrospective reviews of risk adjustment coding are foundational to the financial health and stability of Accountable Care Organizations (ACOs) and Medicare Advantage plans (MAPs). This is increasingly true as value-based contracts and their underlying details become more complex, coding requirements change, and the
Medicare Advantage (MA) plans and Accountable Care Organizations (ACOs) should be reevaluating their vendor strategy in light of coming changes.
This is largely because of a new version of the Hierarchical Condition Category (CMS-HCC) risk adjustment model that CMS released in 2023. It includes changes that will enhance the value of partnering with an experienced vendor for in-depth retrospective and concurrent risk adjustment reviews. Leaders at these organizations will benefit from
