CMS-HCC Model V28: What Health Plans and Providers Must Do to Stay Ahead

As the healthcare landscape evolves, the transition to the CMS-HCC (Hierarchical Condition Category) Model V28 represents a significant shift for

Top Risk Adjustment Coding Companies for Accuracy and Efficiency in 2025

Understanding Modern Risk Adjustment Needs What is Risk Adjustment? Leading Risk Adjustment Technology Companies Technology Innovation in HCC Risk Adjustment

Transforming Outpatient CDI: A Leader’s Guide to AI Implementation

For Outpatient CDI leaders, managing documentation quality in the outpatient setting while fostering positive physician relationships becomes increasingly complex. With

Top 7 AI Risk Adjustment Softwares that are Winning Customer Trust in 2025

Risk adjustment software is no longer just an optional tool; it is a necessity for healthcare organizations aiming to deliver

Understanding Risk Adjustment Coding in Healthcare: A Complete Guide for 2025

The healthcare industry continues to evolve, with risk adjustment coding playing an increasingly central role in ensuring fair reimbursement and

Concurrent Coding in 2025: How AI-Powered Solutions Transform Real-Time Risk Adjustment

Concurrent vs Retrospective Coding: Real-Time Advantage in Risk Capture Real-Time Risk Adjustment: Measured Impact on Documentation Quality Breaking Down Concurrent

Selecting the Right Risk Adjustment Vendor: Essential Checklist for 2025

Risk adjustment services have transformed from simple coding solutions into comprehensive programs impacting every healthcare delivery aspect. Organizations implementing these

Proactive PCPs: Future Lies in Prospective Risk Adjustment Solutions

The ICD-10-CM Official Guidelines emphasize collaboration between healthcare providers and medical coders for accurate documentation. Medical records must include detailed

From the Desk of the CHRO @RAAPID INC

A Shared Vision for People Excellence At RAAPID Inc., our greatest strength lies in our people. This belief drives every

CMS Risk Adjustment Submission Deadlines for 2024, 2025, and 2026: Key Dates for Compliance

In the intricate world of Value based care, where precision and accuracy can make all the difference, one critical aspect

Why Medical Directors are turning to AI for Annual Wellness Visits Management

Introduction Importance of ‘Annual Wellness Visits’ for Providers Hidden Challenges in Traditional Annual Wellness Visits Annual Wellness Visits: Statistically Speaking

Enhancing Care Delivery with Risk Adjustment for ACOs: A 2025 AI-Driven Strategy for Chief Medical Officers

Introduction ACO Key Challenges Faced by CMOs RAAPID Risk Adjustment Solutions: Helping ACOs recognize time-critical challenges Prospective Solution Benefits Key

Maximizing Revenue and Reducing Audit Risk: How Retrospective Risk Adjustment Can Help ACA Plans Meet 2025 Deadlines

Background Maneuvering Through the Nuances of ACA Risk Adjustment ACA Deadlines 2025 And How They Affect Health Plans The Financial

Healthcare Provider Risk Adjustment Preparation

How Providers and Technology Can Collaborate for Quality Care in 2025

Introduction The Importance of Year-End Preparation Why a Comprehensive Year-End Audit Holds Key Relevance Adopting AI-driven Prospective Range of Solutions

Gaining a Holistic Patient Health Perspective With RAAPID’s AI for Optimized Care

Introduction AI-Empowered Foresight For Comprehensive Patient Health Understanding NLP Emerges As The Pivotal Remedy AI-Powered Prospective Suite of Solution Benefits

Advanced AI Technology Sharpens Provider Precision in Healthcare Data Management

The transition to ICD-10 has been a monumental leap in healthcare, expanding from 14,000 to over 70,000 unique diagnosis codes.

Debunking the Myths Around AI in Medical Coding

Coder Dilemma: A Techno-Philosophical Reflection Myth #1: NLP Replaces the Need for Human Coders, Leading to Skill Atrophy. Myth #2:

Bridging the Risk Adjustment Continuum for Collaborative Payer-Provider Success

Risk Adjustment Continuum Is Premised On Payer-Provider Collaboration Understanding The Risk Adjustment Continuum In Changing Times The Importance of Payer-Provider

How Forward-Thinking Health Plans Are Achieving Better Value by Leaving the Past Behind

Evolution of Forward-Thinking Health Plans The evolution of forward-thinking health plans serves as a profound reminder of how modern value-based

RAAPID at RISE West 2024: Showcasing AI-powered Prospective Risk Adjustment Solution & ChaiseIQ to Create Chase List

RISE West 2024: Expanding the Horizons of Healthcare & Risk Adjustment We are thrilled to participate in the Medicare Advantage

Improve Compliance and Financial Performance with a PCP-Centric Risk Adjustment Program

The arrival of new regulations such as the RADV Final Rule and the 2023 Final Rate Notice has led to

How to Resolve HCC Gaps: Best Practices for Healthcare Providers

Table of Content: HCC Primer Workability of HCCs Importance of HCC Coding underlying the risk adjustment process Impact of Hierarchical

Achieving Compliance and Accuracy: The Power of Retrospective Risk Adjustment

As value-based care providers and organizations aim to ensure accurate risk adjustment for Medicare reimbursement, understanding strategies to mitigate audit

Industry Trends to Stay Ahead in Risk Adjustment Coding and Quality Care

Ever wonder how healthcare plans balance their premiums despite enrolling individuals with varying health risks? Enter Risk Adjustment – A

Ethical Dimensions of AI in Shaping the Future of Risk Adjustment

Balancing financial sustainability and high-quality patient care in value based healthcare is challenging, especially with disparities exacerbated by current reimbursement

Best Practices for Health Plans to Run a Profitable & Compliant Risk Adjustment Program

Healthcare Plans are in constant flux, making it vital for Medicare Advantage Organizations (MAOs) and medical groups to keep their

2025 Medicare Advantage Final Rule is out – All You Need to Know

Are you ready for major changes impacting your healthcare costs in 2025? Even though it’s several months off, Medicare is

Trends in Medicare Advantage 2024 and Beyond: Here’s What Industry Experts Are Talking About

In the ever-evolving Medicare Advantage risk adjustment landscape, understanding the shifts and developments is crucial for staying competitive and effective.

How to increase Medicare Advantage Star Ratings by running an effective RA program

How CMS Star Ratings are assessed The Centers for Medicare & Medicaid Services releases its quality Star Ratings each October

In Pursuit Of Accuracy: Impact Of AI On MA Medical Record Audit Solutions

Retrospective Audit and its importance for MA organization Ensure quality care is being provided to Medicare beneficiaries Adhering to the

From Booth to Boardroom – RAAPID Wrap on RISE National 2024

In humble appreciation, we acknowledge that attending conferences transcends mere networking and product showcases. It’s a profound opportunity to graciously

Augmenting Near-Human Reasoning with “Neuro-Symbolic” AI for Profitable and Compliant Risk Adjustment Programs

Introduction Why Neuro-Symbolic AI Neuro-symbolic AI strives to blend the strengths of both domains Neuro Symbolic AI with a mission

Enhancing Risk Adjustment Success: RISE National 2024 & RAAPID’s Innovative Solutions

Rising To The Occasion Amidst a Collaborative Spirit RAAPID’s Cutting-Edge Solutions Unveiled At RISE National 2024 In

CMS Unveils Proposed Changes for 2025 in Medicare Advantage and Part D Advance Notice

Between 2024 and 2025, payments to Medicare Advantage plans are anticipated to increase by an average of 3.70 percent, amounting

Deciphering HCC Risk Adjustment Models in A Nutshell

Introduction The Hierarchical Condition Category (HCC) risk adjustment model, initially introduced by CMS in 2004, serves as a pivotal method

2024 Sweeping Changes to Medicare Advantage Risk Adjustment for Health Plans

CMS UNVEILS THE PROPOSED FINAL RULE FOR MEDICARE ADVANTAGE IMPACTING HEALTH PLANS, PROVIDERS & PATIENTS. The 724-page final rule was

HCC Score: Enhancing Chronic Disease Management in Healthcare

Healthcare providers today face the challenge of effectively managing chronic diseases, a task made more complex by evolving reimbursement models

Adapting to Change: Health Plans and the 2024 Medicare Advantage Star Ratings

The release of the 2024 Medicare Advantage Star Ratings marks a critical juncture for health plans participating in Medicare Advantage

CMS Proposes Major Changes to Medicare Advantage HCC Codes in 2024

Table of Content: Understanding the Revisions in HCC Codes The Impact on RAF Scores RAAPID’s Approach to the New HCC

CMS Proposed Rule for 2025 MA, Prescription Drug Plans

The Centers for Medicare & Medicaid Services (CMS) recently unveiled a comprehensive CMS proposed rule for the 2025 Medicare Advantage

The Role of HCC RAF in Patient Care

Introduction In value-based care, Hierarchical Condition Category (HCC) and Risk Adjustment Factor (RAF) scores are more than just acronyms; they

Navigating the Complexities of Medicare Risk Adjustment for Health Plans

The Medicare Risk Adjustment landscape is a complex one, with health plans constantly striving to ensure accuracy in their HCC

ACO, AI, NLP, Prospective Care, Risk Adjustment

How Accountable Care Organizations (ACOs) Can Implement prospective Risk Adjustment using AI

Introduction Implementing a prospective risk adjustment solution in ACOs presents multifaceted challenges. Daily, there’s the arduous task of aggregating and

How Health Plans Can Reduce Audit Risk with NLP-powered Retrospective Solution

In the complex healthcare landscape, where regulatory oversight is rigorous and financial risks loom large, health plans face an increasingly

Secured Data Interoperability For Providers

The Power of Data Interoperability: What it Means for Prospective Risk Adjustment

Data interoperability has emerged as a pivotal force in healthcare, especially in the context of prospective risk adjustment solutions. This

Leverage RAAPID as Your Trusted HCC Coding Service Provider for VBC

In the ever-evolving landscape of healthcare, health Plans are constantly seeking efficient and reliable solutions to improve their risk adjustment

Addressing Provider Burnout: How Prospective Risk Adjustment Solutions Can Make a Difference

Healthcare providers, including physicians, nurses, and administrative staff, are the backbone of the healthcare industry. Their dedication to patient care

A Glimpse into the President and VP of Sales’ Remarkable Experience at the RISE West 2023

Nestled in the southwest, just a stone’s throw from Dallas Fort Worth international airport, the Omni PGA Frisco Resort where

Unlocking Precision: The Journey to Excellence with RAAPID’s HCC Coding Analysis Tools

Embarking on a Quest for Precision In the sprawling realm of healthcare coding, precision isn’t just an aspiration – it’s

Natural Language Processing to reduce physician burnout

Easing Physician Burnout: How NLP is Transforming Clinical Coding Administrative Burdens

Physicians are the unsung heroes of healthcare, dedicating their lives to saving others. However, the relentless administrative burden of clinical

The Many Benefits of
AI-Based ICD-10 Coding for Medical Coders

The field of medical coding plays a crucial role in healthcare, ensuring accurate and standardized documentation of patient diagnoses, procedures,

Tips to Code Faster & Accurate for CMS/HCC

Are you tired of spending countless hours in order to ensure efficient coding for Centers for Medicare & Medical Services

Prospective chart review analytics solution

RAAPID Pre-Encounter CDI Prospective NLP Analytics for HCC Capture Optimization

The business of healthcare delivery requires a combination of learned, attentive patient care and thorough documentation for subsequent encounter reimbursement.

medical chart auditing solutions for health plans

How Automation Can Transform the Way Health Plans Conduct Their Medical Chart Auditing

As the healthcare industry continues to evolve and become more complex, health plans are constantly seeking new ways to streamline

NLP in healthcare diagnosis codes documentation

Revolutionize Healthcare Documentation: How Natural Language Processing Can Improve Diagnosis Coding Accuracy

As healthcare professionals, we know that accurate documentation is essential for quality patient care, billing, and reimbursement. However, the traditional/manual

HCC Risk Adjustment Coding Review Solution, Best Practices for HCC Coding Reviews, Tips and Tricks For Health Plans During HCC Audits

Avoiding Common Pitfalls in HCC Risk Adjustment Coding Reviews: Tips and Tricks for Health Plans

Are you tired of sifting through mountains of coding reviews, only to find the same mistakes repeated over and over?

Easy-to-integrate HCC Code Review Solutions

Enhance Your HCC Code Review & Audit with Easy-to-Integrate Solutions

As a healthcare professional, you understand the importance of accurate coding and documentation, especially when it comes to Hierarchical Condition

HCC Risk Adjustment Coding for Healthcare Billing

Ensuring Fair Compensation: The Role of HCC Coding in Healthcare Billing

Welcome to our latest blog post about a crucial element of healthcare billing: Hierarchical Condition Category (HCC) coding. If you’re

Best Practices for Successful Risk Adjustment Documentation and Coding in Value-based Care

If you’re still struggling to get a handle on risk adjustment documentation and coding, don’t worry-you’re not alone. With constantly

How Risk Adjustment NLP Benefits Healthcare Payers

To remain solvent and profitable, healthcare payers must constantly seek new ways to optimize their operations, improve reimbursement accuracies, and

MEAT-enabled HCC coding solutions for Risk Adjustment

From Confusion to Clarity: Simplify HCC Coding with
MEAT-Enabled Solution

Are you tired of the complexity and confusion that comes with hierarchical condition category (HCC) coding? Have you been struggling

NLP tech for retrospective HCC code review

RAAPID’s NLP technology for Retrospective HCC Code review

With many healthcare organizations transitioning to value-based care (VBC) programs, ensuring accurate hierarchical condition category (HCC) documentation that leads to

HCC coding review & audit solution provider

Checklist for MA organizations to ensure accurate reimbursements

With the recent Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) Final rule update shared by the Centers for Medicare

Best Company to Outsource HCC Coding Services in US

How to choose the right HCC Coding Service Provider

In the release of the Medicare Advantage Risk Adjustment Data Validation Final Rule by the US Department of Health and

Outsource HCC Medical Coding Services In the US

Benefits of Outsourcing HCC Medical Coding Services to a Technology Solution Provider

Are you preparing for the upcoming 2023 Mid-Year risk adjustment data submission? Are you worried about handling the increasing number

Impact of Accurate HCC Coding for CMS Reimbursements

Hierarchical condition category (HCC) coding is a risk-adjustment model which is designed to estimate future healthcare costs for patients as

Importance of Risk Adjustment in
Value-Based Care

Risk Adjustment is a statistical process that considers the underlying health status and health spending of an enrollee in an

Red Flags: OIG Chart Reviews of Medicare Advantage records

Healthcare fraud and misuse is a federal offense and negatively impacts care delivery on the whole. It impacts healthcare costs

Medical Coders in Revenue Cycle Management

The role of Medical Coders in the Revenue Cycle Management

Medical coders play an important role in the revenue cycle management for the healthcare ecosystem, however, they are rarely mentioned.

Retrospective Audit: How RAAPID is helping Health Plans & Providers

An AI-Based Risk Adjustment Coding solution does more than simply identify bad claims to fix them, it allows Medicare Advantage

Data-driven Analysis and Solutions with RAAPID

There are 3,834 Medicare Advantage Programs¹ as of 2022, and the total Medicare Advantage enrollees have doubled since the past

Conventional vs. AI-Driven health care risk adjustment solutions

The global natural language processing (NLP) market revenue is expected to reach 43 billion in 2025.¹ NLP is helping value-based

4 Medical Coding practices for health care coders and payers in Risk adjustment

Hierarchical Condition Categories (HCCs) and ICD-10-CM codes risk adjustment solution is becoming a trending topic amongst health care payers and

Retrospective Solution for Audit: The role of Payers in Healthcare

With the modern technology inclusion in the health care ecosystem, payers will have to be coerced to adapt with many

Payers in Health care: Chart Review Trends to watch in 2022

A survey conducted to understand the healthcare payer market size, shares, trends, and analysis stated that the global payer healthcare

Retrospective Chart Audit Approach & Its Solution

One of the most common barriers to conducting patient chart reviews for the health care payer and providers is that

NLP & AI: Insurance Industry Future Trends for Risk Adjustment

A Study by the National Library of Medicine¹ has stated that several types of Artificial Intelligence (AI) are being adopted by

Clinical Chart Review: Traditional vs RAAPID

In a recent study by MarketsandMarkets conducted to understand the advantages of artificial intelligence (AI) in the healthcare market, AI

RADV Audits in 2025: What MAOs Must Know About the 2023 Final Rule and the PY2018 Audit Risks