Risk adjustment involves billing diagnosis information that is properly supported in the medical record. It estimates the expected annual cost of care and aligns payments to the complexity of a patient’s conditions. Because payments rise with diagnosis severity, an...
Healthcare Fraud Shield will be attending the Medical Cost Containment Series to engage with payer leaders focused on cost control and payment accuracy. Meet with our team to discuss how AI-driven insights and flexible, integrated solutions help reduce improper...
Healthcare Fraud Shield will be attending the MES Conference to connect with healthcare leaders focused on program integrity, compliance, and analytics. Join our team to explore how AI-powered solutions and integrated workflows help payers identify risk earlier,...
Healthcare Fraud Shield (HCFS) will be attending the NAMPI 2026 conference and exhibiting in the virtual exhibit hall. Stop by booth 32 to see how the HCFSPlatform helps health plans detect and prevent fraud, waste, abuse, and error across the full claim lifecycle....
Recent actions by the Centers for Medicare & Medicaid Services (CMS), including targeted spending reviews and the Comprehensive Regulations to Uncover Suspicious Healthcare initiative, known as CRUSH, reflect a measurable shift in federal oversight expectations....
