As part of our series “How To Effectively Leverage Data To Take Your Company To The Next Level,” I had the pleasure of interviewing Dr. Arun Hampapur. Founder and CEO of Bloom Value Corporation (a technology…

Defensible risk adjustment ensures every Medicare Advantage code is clinically justified, transparent, and traceable, reducing audit, financial, and reputational risks....

The investigation has triggered bipartisan concern, with lawmakers scrutinizing whether risk adjustment practices have crossed ethical lines. The move signals a shift from passive oversight to active enforcement, putting the future of MA funding and the industry's credibility at a tipping point.

For healthcare providers, prior authorization represents an additional layer of administrative complexity. They must familiarize themselves with specific requirements, gather supporting documentation,…

Medicare Advantage Organizations (MAOs) - including health plans, IPAs, MSOs, and risk-bearing providers are grappling with a wave of unprecedented challenges. The implementation of CMS’s Hierarchical Condition Category (HCC) risk adjustment model Version 28 (V28) is already reshaping the industry.

Healthcare organizations today are continuously seeking opportunities to lift margins in the midst of increasing financial challenges. NewCare IPA is one example of an independent physician organization…