Risk adjustment could continue to draw on diagnoses from medical claims, but in a more targeted fashion that focuses on diagnoses that supply additional predictive information and are less affected by ...
The United States spends more on healthcare than any other developed country in the world. In 2021, U.S. national health spending was 18.3% of GDP—and by 2030, it is projected to reach nearly 20%, or ...
The risk factors for breast cancer have been defined in several studies but there is deficient data for specific subtypes. We report here the pathological characteristics of a breast cancer cohort and ...
Risk adjustment of quality measures using clinical risk factors is widely accepted; risk adjustment using social risk factors remains controversial. We argue here that social risk adjustment is ...
If finalized, these proposals will generally take effect on January 1, 2025, unless otherwise noted. Both the individual and small group market risk adjustment system are based on a set of regression ...
In fact, a September 2021 report from HHS’ Office of Inspector General highlighted potential concern around Medicare Advantage plan risk adjustment practices. The report found that 20 plans received ...
Artificial intelligence (AI)-enabled tools such as natural language processing (NLP) have been integrated into a wide range of applications, including risk adjustment coding tools, for greater ...
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