Top 20 MA Plan Selects Invent Health for AI Risk Adjustment Coding
A top 20 Medicare Advantage plan has selected Invent Health and gone live on Coder Workbench 2.0. AI-assisted risk adjustment coding that runs natively inside the electronic health record.
Immunization Care Gaps: 3 Leaks Costing Plans Stars
Why do vaccinated members still show as immunization care gaps? The three data leaks that cost plans Stars revenue, and how to find yours by year-end.
Encounter Submissions: Can You Prove Every Coded Diagnosis Reached CMS?
Most plans cannot prove every coded diagnosis reached CMS. Invent Health’s CEO announces Encounter Submissions, the closed loop that ends the guessing.
Behavioral Health: Why Your Risk Scores Keep Missing It (and Who Pays for It)
Behavioral health is the diagnosis your risk model keeps missing, and it hits underserved members hardest. See why it happens and how plans fix it under V28.
He Won’t Go to the Doctor…So How Does Your Plan Know He’s Sick?
Many male members delay preventive care, creating documentation gaps and hidden risk. Learn how prospective risk adjustment strategies can help health plans identify and manage risk earlier.
How NLP Improves HCC Capture Accuracy
See how NLP lifts HCC capture accuracy by surfacing evidence, keeping a coder in the loop, and measuring capture where it pays: CMS acceptance.
Revenue Integrity in Risk Adjustment
Revenue integrity in risk adjustment depends on what CMS accepts, not what you send. See where RAF leaks and how analytics closes each point of loss.
CY 2027 Medicare Advantage Final Rate Announcement
CMS finalized the CY 2027 Medicare Advantage and Part D Rate Announcement with a 2.48% payment increase and a softer normalization impact of -1.12%. The final rule retains the 2024 Part C risk adjustment model and excludes audio-only and unlinked chart review diagnoses from RAF calculations. Learn what these changes mean for health plan compliance, provider workflows, and risk adjustment strategy heading into 2027.
How to Find Documentation Gaps in Risk Adjustment Coding
Documentation gaps in risk adjustment cost RAF and audit standing. See where they hide, how to rank them by closure odds, and how to close them earlier.
CMS CY2027 ADVANCE NOTICE
The CMS CY2027 Advance Notice marks the end of volume-led risk adjustment. We break down the population shifts, HCC volatility, and the new execution hierarchy CMS is signaling in our CY2027 Health Plan Playbook.
