Risk Score Accuracy Archives

MSSP 2027 Proposed Rule: What Medicare ACO Leaders Should Watch

Two women in an office look at a computer screen displaying charts and graphs related to the MSSP 2027 Proposed Rule. One woman is seated, while the other stands and points at the monitor, discussing data. Bright, modern workspace environment.

On July 14, 2026, CMS released the Medicare Shared Savings Program (MSSP) 2027 Proposed Rule as part of the CY2027 Physician Fee Schedule…

Rosina.Natter@inovalon.com

The Clover Decision Changed More Than One Plan’s Star Rating

A woman holding a tablet presents data on a screen displaying a rising bar graph in a bright, modern office setting, illustrating how The Clover Decision changed more than one plan’s Star Rating.

On June 9, 2026, CMS informed Clover Health that its 2026 Medicare Advantage Star Rating was no longer 3.5 stars —…

Mariaelisa.Papadeas@inovalon.com

The Hidden Costs of Fragmented Care Gap Programs

A woman with long braids sits at a desk, typing on a laptop. She is focused on her work, possibly researching care gap programs, with a pen holder and notebook nearby. Abstract white rectangles overlay the modern, bright office setting.

The pressure on healthcare payers has never been higher: do more, spend less, move faster. With nearly $496 billion spent annually on healthcare administration, tightening…

Mariaelisa.Papadeas@inovalon.com

In Home Assessment Documentation Gets Stronger with Purpose-Built Solutions

A caregiver kneels beside an elderly person in a wheelchair, offering support in a sunlit hallway of what appears to be a care facility or home, embodying the dedication essential for effective care gap closure and patient assessment.

In home assessment vendors aren’t tech companies. Yet many still spend too much time maintaining homegrown tools instead of delivering…

Mariaelisa.Papadeas@inovalon.com

Proactive HEDIS Reporting Strategy: Year-Round Readiness

A woman sits at an office desk, writing in a notebook while holding papers related to HEDIS reporting, with a computer monitor, plant, and office supplies around her.

Every HEDIS® season tells the same story, but with very different endings. In our recent poll, 38% of healthcare quality professionals…

Mariaelisa.Papadeas@inovalon.com

Better Data, Better Care: Improving Payer-Provider Collaboration

Smiling female physician speaking with a happy patient as they both look at a computer screen

In value-based care, shared goals between health plans and providers are only possible when both parties are working from the…

Courtney.Donlan@inovalon.com

Introducing the Inovalon Healthcare Data Lake Portal: All Your Data, One Central View

woman sitting at a cubicle working on desktop computer

If you’re tired of stitching together data from multiple systems just to answer a single question, you’re not alone. Healthcare…

abilityinov

RADV Audits: Taking a Proactive Approach in the Face of New Regulations

A young man wearing glasses and a blue shirt sits at a desk in an office, reviewing RADV Audits papers in his hand while working on a computer. The background is bright with large windows.

It’s no longer a question of if, but when. In May 2025, the Centers for Medicare & Medicaid Services (CMS)…

Mariaelisa.Papadeas@inovalon.com

Medicaid Budget Cuts Test Risk Adjustment Program Readiness

In value-based care, shared goals between health plans and providers are only possible when both parties are working from the…

abilityinov

Mastering Record Retrieval: Smarter MRR Strategies for Risk Adjustment Success

A woman is working on a laptop, using Inovalon's Converged Record Review.

Risk adjustment professionals are walking a tight rope without a net when it comes to medical record reviews (MRRs) and…

abilityinov

RISE National 2025 Rewind: Recommendations for Improving Compliance

Now that RISE National 2025 has concluded, it's time to recharge and reflect. The saying “the only constant is change”…

abilityinov

Enhancing Healthcare Data Management Query Efficiency With Pre-Written Views

Two people look at a computer monitor as they compare data.

Healthcare data is more than simply a byproduct of care – it’s the foundation for smarter decisions, better care delivery,…

abilityinov

Electronic Medical Records Retrieval Myths: Common Challenges and Misconceptions

A man sitting at a desk using his computer.

In the rapidly evolving world of healthcare, technology plays a crucial role in shaping patient care and outcomes.

abilityinov

How Healthcare Risk Adjustment and Detailed Documentation Can Improve Member Care

Healthcare provider using healthcare patient assessment software.

Healthcare risk adjustment plays an essential role in the health plan-provider relationship. At the center of this relationship is patient…

Inovalon Admin In Payer

Buy or build? 4 crucial considerations for risk adjustment software decisions

A man wearing glasses and a light-colored shirt smiles while working on a laptop with risk adjustment software at a bright, modern desk, surrounded by plants and office supplies.

It is no secret that healthcare risk adjustment is an evolving landscape for all lines of business. As healthcare adapts…

Inovalon Admin In Payer

Proactive CMS RADV Compliance: Identify Potentially Over-Coded Conditions Early On

Healthcare professional looking at compliance data

Every year, the Centers for Medicare and Medicaid Services (CMS) conducts Medicare Advantage Risk Adjustment Data Validation (RADV) audits on…

Inovalon Admin In Payer

How to realize accurate HCC documentation amid the COVID-19 pandemic

According to CMS' Office of the Actuary, healthcare spending is predicted to increase at an average annual rate of 5.5%, reaching…

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