As the healthcare industry continues to shift toward value-based care, precise Hierarchical Condition Category (HCC) risk adjustment is more important than ever for organizations aiming to optimize reimbursements. The 2025 CMS risk model updates will demand enhanced precision, adaptability, and compliance. To thrive, healthcare organizations must prioritize accuracy
For revenue cycle leaders, maintaining compliance while minimizing financial risk is an ongoing challenge. As healthcare entities continue to see increasing risk from changes to government policies, shifting patient demographics, and shrinking margins, risk management will become an increasingly essential focus for survival. One of the most effective tools for achieving risk management goals is examining the application of Comprehensive Error Rate Testing (CERT) and how it impacts organizations that deal
After releasing new HCC coding guidelines, CMS has published the latest Medicare Advantage Rate announcements, sparking speculation around the impact on providers. These potential impacts include shifts in Medicare Advantage enrollment, questions around the effects of changing economic conditions, and increases in payments to Medicare Advantage plans. All of this is unfolding at a time when government spending is under increased criticism – Medicare Advantage plans are known to cost the
We’ve assembled the latest news for healthcare revenue cycle leaders to help you stay on top of industry challenges and adapt your revenue cycle
In the high-stakes world of healthcare finance, where razor-thin margins and rising regulatory scrutiny are the norm, medical coding audits have become essential for maintaining revenue integrity, ensuring medical coding compliance, and supporting long-term sustainability. While many providers focus on coding compliance at a surface level,
