In some healthcare payment models, like those we often see in managed care plans and value-based care setups, providers receive a fixed amount per patient, aiming to cover all expenses

Medicare Advantage (MA) stands as a crucial component of the American healthcare landscape, offering private insurance alternatives to traditional fee-for-service (FFS) Medicare. A cornerstone of the MA framework is its

Understanding how healthcare economics work can be as confusing as navigating without a map, like being a pirate on the high seas. For groups called Accountable Care Organizations (ACOs), who

Refining Strategies to Elevate Medical Coding Accuracy In the realm of healthcare administration, medical coding serves as the linchpin, translating intricate diagnoses and procedures into numerical codes that underpin the

Computer-Assisted Coding (CAC) has emerged as a critical tool in healthcare, aiming to streamline the complex process of medical coding. By automating the coding process, CAC systems promise increased efficiency,

Medicare Advantage Plans have long been a cornerstone of healthcare coverage for seniors in the US. These plans, provided by private insurance companies and approved by Medicare, offer an alternative

The landscape of CMS Star Ratings for Medicare Advantage plans with prescription drug coverage (MA-PD plans) witnessed a shift in 2024, with the average Star Rating dropping from 4.14 in

As the new year unfolds, healthcare professionals are not only setting personal resolutions but also strategizing for success in their respective fields. Among the critical considerations for 2024 is risk

As the healthcare landscape continues to evolve, it is imperative for Medicare Advantage Organizations (MAOs) and stakeholders to continuously assess opportunities for innovation and improvement within the Medicare Advantage risk