Two mechanisms that MA plans use to identify diagnoses that are not available for beneficiaries in traditional Medicare are in-home health risk assessments and chart reviews. Using MA encounter ...

The tool, which has been co-developed with WTW over seven years, offers a granular approach to insurance pricing.

Medicare Advantage (MA) companies receive higher risk-adjusted payments from the Centers for Medicare & Medicaid Services (CMS) for enrollees who are sicker, which helps to ensure that plans ...

A recent OIG report found that diagnoses reported in 2022 Medicare Advantage (MA) encounter data based only on health risk assessments (HRA) and HRA-linked chart reviews resulted in CMS making ...

AI-powered framework combines CNNs and knowledge graphs to detect credit risk early in internet finance firms, enhancing prediction accuracy and decision transparency.

This pattern holds consistent across sectors, suggesting a broader industry-wide challenge in operationalizing climate risk assessment. Among those who have fully integrated physical risk ...