MedCity News August 11, 2025
As CMS ramps up its RADV initiatives in the months ahead, plans should ensure their risk adjustment programs meet the highest standards of accuracy and compliance. Prospective and retrospective analytics enhanced by AI can help plans work with providers to optimize documentation at the point of care and identify coding errors during audit preparation.
Artificial intelligence (AI)-enabled tools such as natural language processing (NLP) have been integrated into a wide range of applications, including risk adjustment coding tools, for greater efficiency and accuracy in the healthcare industry. For Medicare Advantage (MA) plans, these tools can significantly improve the accuracy of diagnostic and hierarchical condition category (HCC) data needed to support risk adjustment programs and help ensure appropriate reimbursement.
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