As the Medicare Advantage market continues to evolve amid regulatory change, margin pressure, and ongoing member movement, it remains a crucial growth and performance priority for many health plans.

For most of Medicare Advantage's history, RADV audits were sporadic. CMS selected a handful of contracts each year. The ...

This guidance sets out the minimum requirements to deliver quality surveillance for patients at risk of hepatocellular carcinoma (HCC). It supports hepatology, gastroenterology, and radiology services ...

Background and aims Chronic inflammation induced by chronic hepatitis B virus (HBV) infection increases the risk of hepatocellular carcinoma (HCC). However, little is known about the immune landscape ...

For example, despite the strong evidence for WNT/β-catenin pathways in HCC, this pathway has so far been difficult to target pharmacologically. Cancer cell reliance on an intrinsic oncogene mutation ...

Medicare beneficiaries can receive their benefits either through private plans, known as Medicare Advantage (MA) plans, or traditional Medicare. MA plans now cover more than half of all beneficiaries, ...

Update 3/5/26: We have updated our estimate for Medicare Advantage (MA) overpayments using the most recent February 2026 CBO baseline. We now find MA overpayments will total $1.3 trillion between 2027 ...

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 ...

Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains a significant global health challenge due to its high prevalence and poor prognosis. Recent advances have revealed that ...

Diagnosis Coding: Accurate diagnosis coding is critical for risk adjustment in the age of value-based care. It's appropriate to select an ICD-10 code for each active condition during each patient ...