A federal lawsuit claims that UnitedHealth Group, the largest Medicare Advantage insurer in the country, is coding medical claims inappropriately for monetary gain. But while the lawsuit doesn't ...

The mid-revenue cycle is where medicine, documentation, and coding converge to produce the record that determines reimbursement, risk adjustment metrics, and quality scores. Physicians make the ...

Apixio Inc., the data science company for healthcare, today unveiled Compliance Auditor, the first application of its kind in the marketplace and latest addition to the company's HCC Profiler solution ...

CMS and policy makers could pursue simple, incremental reforms to reduce overpayment in Medicare Advantage while also paving the way for longer-term solutions to reduce incentives to upcode. To ...

Change Healthcare has announced it is collaborating with Health Fidelity on a risk adjustment solution to provider greater accuracy for better compliance and more precise reimbursement. Health ...

A federal lawsuit has focused attention on how the industry uses medical codes for risk adjustment. While the lawsuit doesn’t involve physician practices, it’s a heads-up for them to pay attention to ...

More Medicare Advantage plans got star ratings of four or more for 2022 as some experts renew criticism of risk adjustment practices that can lead to greater quality performance.

Medicare Advantage is the dominant Medicare delivery system, now covering 54% of all Medicare enrollees. With the increase in enrollment and federal spending, however, has come increased scrutiny from ...

Healthcare risk management solutions company Talix has launched Coding InSight for Payers. Coding InSight for Payers is designed to help health plans automate and streamline risk adjustment processes ...

NEW YORK, February 04, 2026--(BUSINESS WIRE)--Datavant, the data collaboration platform trusted for healthcare, today announced that it has been named the #1 Ranked 2026 Best in KLAS Award winner in ...