Care Decoded

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Care Decoded

TopHealth Media

8 episodes

3 weeks ago

Welcome back to Care Decoded! In this episode, we dive into the second part of our RADV miniseries, shifting focus from what RADV is, to the crucial role of frontline providers in ensuring accurate, defensible documentation as part of everyday care. Host Mark McKeown is joined once again by Colleen Gianatasio, an expert in risk adjustment and value-based care with over 20 years of experience. Together, they explore why provider documentation is the foundation for RADV compliance, the biggest ...

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Episodes (8/8)

Care Decoded

How Provider-First Tech and Collaboration Drive RADV Audit Success

3 weeks ago

17 minutes

Care Decoded

Building a Proactive RADV Audit Readiness Plan: People, Process, Technology, and More

Welcome to a brand new episode of Care Decoded! In this episode, host Mark McKeown is joined by renowned risk adjustment and coding expert Colleen Gianatasio to kick off a special two-part series diving into CMS’s heightened focus on RADV (Risk Adjustment Data Validation) audits. As Medicare Advantage plans face unprecedented scrutiny with CMS now pledging to audit all eligible contracts every year, the stakes have never been higher for compliance, documentation, and risk management. Together...

1 month ago

24 minutes

Care Decoded

Closing Care Gaps and Turning Data Into Action for Better Patient Outcomes

Welcome to another episode of Care Decoded, the podcast where we break down the most pressing issues in modern healthcare. In today’s episode, host Michael Lesnik, VP of Provider Sales at Inferscience, sits down with Dr. Sunil Nihalani, CEO of Inferscience and a practicing physician, to unravel the complexities of “care gaps”, those critical yet often overlooked opportunities to improve patient care and outcomes. Drawing on over fifteen years of experience in healthcare IT and value-based car...

1 month ago

24 minutes

Care Decoded

Decoding CMS HCC V28 for Real-World Impact

Welcome back to Care Decoded, the podcast where we make sense of the evolving world of healthcare documentation, coding, and clinical AI. In today’s episode, hosts Dr. Sunil Nihalani and Biodun Kajopaiye, Risk Adjustment and Stars Manager at CareFirst BlueCross BlueShield, dive into the seismic changes brought about by version 28 of the CMS HCC risk adjustment model. Whether you’re a seasoned pro or new to the world of risk adjustment, this episode will break down exactly what V28 is, how it’...

3 months ago

32 minutes

Care Decoded

Tackling Physician Burnout: The Hidden Costs of Clunky Documentation Systems

Welcome back to Care Decoded, the show where we break down the complexities of risk adjustment, documentation, and the evolving role of AI in healthcare. In today’s episode, host Lucy Medina sits down with Dr. Sunil Nihalani, CEO of Inferscience and practicing physician, to tackle a topic that hits close to home for every clinician: documentation burnout. Together, they pull back the curtain on how clunky EHR systems, endless documentation demands, and poorly designed workflows are taking a t...

3 months ago

19 minutes

Care Decoded

Bridging Risk Adjustment and Quality: Turning Data Into Meaningful Patient Outcomes

Welcome to another episode of Care Decoded, the show where we break down the complexities of risk adjustment, documentation, and AI to power better healthcare. In today’s episode, host Dr. Sunil Nihalani is joined by Subbu Ramalingam — a seasoned former health plan executive and expert at the intersection of star ratings, risk adjustment, and healthcare quality. Together, Sunil and Subbu dig into why star ratings aren’t just about checking boxes, but about truly improving patient care and exp...

4 months ago

44 minutes

Care Decoded

Why Risk Adjustment Matters More Than Ever: Sunil’s Journey From Medicine to Health Tech

Welcome to the very first episode of Care Decoded, where we peel back the layers of healthcare innovation with people who are reshaping the industry from the inside. In this episode, Dr. Sunil Nihalani, Founder and CEO at Inferscience, dives into his unconventional journey from his childhood in India where his family was far from medicine to the creation of Inferscience, a company dedicated to making risk adjustment and clinical documentation more efficient for physicians and payers. Sunil ta...

5 months ago

29 minutes

Care Decoded

Care Decoded - Promo

Care Decoded is the go-to podcast for clinicians, health plan leaders, and quality champions navigating the evolving world of risk adjustment, value-based care, and smarter documentation. Hosted by Inferscience, this show takes you inside the workflows, decisions, and technologies that turn clinical complexity into clarity. From demystifying HCCs and RAF scores to decoding CMS changes and exploring the impact of AI, we help you understand the data behind every diagnosis. This show isn't about...

5 months ago

1 minute