The Centers for Medicare & Medicaid Services releases its quality Star Ratings…
Retrospective Audit and its importance for MA organization Ensure quality care is being provided to Medicare beneficiaries Adhering to the
In humble appreciation, we acknowledge that attending conferences transcends mere networking and product showcases. It’s a profound opportunity to graciously
Introduction Why Neuro-Symbolic AI Neuro-symbolic AI strives to blend the strengths of both domains Neuro Symbolic AI with a mission
Rising To The Occasion Amidst a Collaborative Spirit RAAPID’s Cutting-Edge Solutions Unveiled At RISE National 2024 In
As the healthcare landscape evolves, the transition to the CMS-HCC (Hierarchical Condition Category) Model V28 represents a significant shift for
Between 2024 and 2025, payments to Medicare Advantage plans are anticipated to increase by an average of 3.70 percent, amounting
Introduction The Hierarchical Condition Category (HCC) risk adjustment model, initially introduced by CMS in 2004, serves as a pivotal method
Clinicians no doubt play a vital role in recording patients’ conditions using HCC codes, but they shouldn’t shoulder the challenging
Health plans, globally have begun to realize the pompous value of Prospective risk adjustment programs, and deservedly so. Prospective risk
CMS UNVEILS THE PROPOSED FINAL RULE FOR MEDICARE ADVANTAGE IMPACTING HEALTH PLANS, PROVIDERS & PATIENTS. The 724-page final rule was
The Department of Health & Human Services, on May 5, 2023, communicated to the Centers for Medicare & Medicaid Services
Healthcare providers today face the challenge of effectively managing chronic diseases, a task made more complex by evolving reimbursement models
The release of the 2024 Medicare Advantage Star Ratings marks a critical juncture for health plans participating in Medicare Advantage
Table of Content: Understanding the Revisions in HCC Codes The Impact on RAF Scores RAAPID’s Approach to the New HCC
The Centers for Medicare & Medicaid Services (CMS) recently unveiled a comprehensive CMS proposed rule for the 2025 Medicare Advantage
Introduction In value-based care, Hierarchical Condition Category (HCC) and Risk Adjustment Factor (RAF) scores are more than just acronyms; they
The Medicare Risk Adjustment landscape is a complex one, with health plans constantly striving to ensure accuracy in their HCC
Introduction Implementing a prospective risk adjustment solution in ACOs presents multifaceted challenges. Daily, there’s the arduous task of aggregating and
In the complex healthcare landscape, where regulatory oversight is rigorous and financial risks loom large, health plans face an increasingly
Data interoperability has emerged as a pivotal force in healthcare, especially in the context of prospective risk adjustment solutions. This
In the ever-evolving landscape of healthcare, health Plans are constantly seeking efficient and reliable solutions to improve their risk adjustment
The ICD-10-CM Official Guidelines for Coding and Reporting emphasize the vital collaboration between healthcare providers and coders to ensure the
Healthcare providers, including physicians, nurses, and administrative staff, are the backbone of the healthcare industry. Their dedication to patient care
Healthcare is a complex and rapidly evolving field, and health plans play a crucial role in ensuring that individuals receive
In today’s healthcare landscape, the ability to access and leverage patient data efficiently is paramount. Providers, tasked with delivering high-quality
In the intricate world of healthcare, where reimbursement and quality of care are intricately linked, the accuracy of RAF (Risk
In 2021, the global AI in healthcare market exceeded 11 billion US dollars in value, and projections indicate that it
HCC coding is a critical component of risk adjustment in healthcare. Understanding it’s basics is essential for healthcare providers, administrators,
Today, health plans play a pivotal role in ensuring that patients receive the care they need while managing costs efficiently.
Nestled in the southwest, just a stone’s throw from Dallas Fort Worth international airport, the Omni PGA Frisco Resort where
Embarking on a Quest for Precision In the sprawling realm of healthcare coding, precision isn’t just an aspiration – it’s
August 22, 2023, Kentucky, USA– RAAPID, a leading innovator in the field of Natural Language Processing (NLP) technology solutions for
In the rapidly evolving landscape of healthcare, where technology is reshaping the way we approach medical treatments, diagnostics, and patient
Physicians are the unsung heroes of healthcare, dedicating their lives to saving others. However, the relentless administrative burden of clinical
Eighty per cent of medical data remains unstructured and untapped after it is created (e.g., text, image, signal, etc.)¹ In
Greetings, fellow healthcare administrators, coders, and billers! Today, we embark on a thrilling adventure through the realm of Clinical NLP
In the fast-paced world of healthcare, efficient data collection and organization are crucial for providing quality care. With the advent
In the bustling realm of healthcare risk adjustment, today, risk adjustment vendors play a pivotal role in ensuring accurate and
The field of medical coding plays a crucial role in healthcare, ensuring accurate and standardized documentation of patient diagnoses, procedures,
In the dynamic landscape of healthcare administration, health plans and Medicare Administrative Contractors (MAC) play a crucial role in processing
If your organization lacks the necessary expertise and experience in risk adjustment (RA) methodologies, coding, and documentation, outsourcing can be
Are you tired of spending countless hours in order to ensure efficient coding for Centers for Medicare & Medical Services
How to Compare Competing AI Vendor’s Engine Performance Prior to Purchase NLP in healthcare for risk adjustment is among the
The business of healthcare delivery requires a combination of learned, attentive patient care and thorough documentation for subsequent encounter reimbursement.
As the healthcare industry continues to evolve and become more complex, health plans are constantly seeking new ways to streamline
As the healthcare industry continues to evolve, medical coding has become an essential component of efficient and effective patient care.
As healthcare professionals, we know that accurate documentation is essential for quality patient care, billing, and reimbursement. However, the traditional/manual
Are you tired of sifting through mountains of coding reviews, only to find the same mistakes repeated over and over?
As a healthcare professional, you understand the importance of accurate coding and documentation, especially when it comes to Hierarchical Condition
Welcome to our latest blog post about a crucial element of healthcare billing: Hierarchical Condition Category (HCC) coding. If you’re
If you’re still struggling to get a handle on risk adjustment documentation and coding, don’t worry-you’re not alone. With constantly
To remain solvent and profitable, healthcare payers must constantly seek new ways to optimize their operations, improve reimbursement accuracies, and
Are you tired of the complexity and confusion that comes with hierarchical condition category (HCC) coding? Have you been struggling
Healthcare organizations are under tremendous financial pressure to accurately identify risk-adjusted diseases to ensure maximum yet allowable Medicare reimbursements. Identify
With many healthcare organizations transitioning to value-based care (VBC) programs, ensuring accurate hierarchical condition categorie (HCC) documentation that leads to
With the recent Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) Final rule update shared by the Centers for Medicare
In the release of the Medicare Advantage Risk Adjustment Data Validation Final Rule by the US Department of Health and
Are you preparing for the upcoming 2023 Mid-Year risk adjustment data submission? Are you worried about handling the increasing number
As required by law, Centers for Medicare and Medical Services (CMS’) payments to Medicare Advantage Organizations (MAOs) are adjusted based
The global market size of NLP in health care is projected to reach USD 7.2 billion by 2027 from USD
Hierarchical condition category (HCC) coding is a risk-adjustment model which is designed to estimate future healthcare costs for patients as
Risk Adjustment is a statistical process that considers the underlying health status and health spending of an enrollee in an
Healthcare fraud and misuse is a federal offense and negatively impacts care delivery on the whole. It impacts healthcare costs
Retrospective chart review (RCR), also known as medical record review is a widely applicable research analysis, methodology, in the healthcare
As per an abstract shared by the National Library of Medicine, a chart review is a methodology to determine a
Risk adjustment medical coding professionals are quite aware of the need for having clear and concise medical records documentation before
In order to determine the health costs of a value-based care patient, Medicare Advantage Organizations (MAOs), Commercial Affordable Care Act
In a recent audit finding shared by the Office of Inspector General (OIG), a Medicare Advantage (MA) healthcare organization ended
The Hard fact! Physicians are often Over burdened with their Patient care routine, and thus often slip off writing medical
The goal of a retrospective audit solution is to deep-dive into claim data comparison and underline and validate high-risk areas
Medical coders play an important role in the revenue cycle management for the healthcare ecosystem, however, they are rarely mentioned.
An AI-Based Risk Adjustment Coding solution does more than simply identify bad claims to fix them, it allows Medicare Advantage
There are 3,834 Medicare Advantage Programs¹ as of 2022, and the total Medicare Advantage enrollees have doubled since the past
Risk adjustment in healthcare, also known as ‘case-mix management,’ administered by the Centers for Medicare & Medicaid Services (CMS), is
With value-based care programs¹ being focused by Accountable Care Organizations² (ACOs), which includes a group of doctors and healthcare providers
The global natural language processing (NLP) market revenue is expected to reach 43 billion in 2025.¹ NLP is helping value-based
Hierarchical Condition Categories (HCCs) and ICD-10-CM codes risk adjustment solution is becoming a trending topic amongst health care payers and
With the modern technology inclusion in the health care ecosystem, payers will have to be coerced to adapt with many
A survey conducted to understand the healthcare payer market size, shares, trends, and analysis stated that the global payer healthcare
One of the most common barriers to conducting patient chart reviews for the health care payer and providers is that
A Study by the National Library of Medicine¹ has stated that several types of Artificial Intelligence (AI) are being adopted by
In a recent study by MarketsandMarkets conducted to understand the advantages of artificial intelligence (AI) in the healthcare market, AI
Risk Adjustment for healthcare payers and providers determines the coverage rate for patient care and accurately maps the population’s risk
Organizations view Medicare risk adjustment as a necessity but don’t you look at it as a strategic approach too. With
The global market size of artificial intelligence (AI) in the healthcare industry is expected to reach more than $28 billion
For a healthcare payer to ensure its population’s risk burden is accurately mapped, exquisite technology tools must be used to
Risk Assessment and Risk Adjustment, are they synonymous? Risk Assessment and Risk Adjustment is a statistician tool used to moderate
Around the US, healthcare organizations are struggling with the transition to value-based care, rising costs, and uneven quality despite being
The term ‘Artificial Intelligence’ or ‘AI’ may sound appalling to some, but it has been used for decades and its
