Prospective, Concurrent, and Retrospective Ri...
Risk adjustment is often discussed as a Medicare Advantage problem. In actuality, it affects every organization whose reimbursement, shared savings, or quality performance depends on accurately reflecting the complexity of their patient population.
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June 19, 2026
Top 7 Physician Coding Mistakes Trigg...
Why is physician coding creating more revenue risk in 2026? Physician coding is no longer just a compliance function sit...
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June 17, 2026
Why Home Health Billing Services Are ...
On May 13, 2026, the Centers for Medicare and Medicaid Services imposed an unprecedented nationwide six-month moratorium...
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June 12, 2026
The New Era of HCC Risk Adjustment: W...
For years, many Medicare Advantage organizations treated HCC risk adjustment as a volume exercise: capture more diagnose...
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June 10, 2026
Outsourcing Medical Billing for Healt...
Most healthcare organizations don't decide to outsource medical billing because of a single crisis. The decision builds ...
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June 08, 2026
Denial Prevention vs. Denial Manageme...
In 2025, U.S. hospitals spent $18 billion overturning claims denials. Not losing those claims. Not writing them off. Ov...
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June 07, 2026
OIG Flags $462 Million in Medicare Ad...
On June 1, 2026, the HHS Office of Inspector General published one of the most significant Medicare HCC risk adjustment ...
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June 06, 2026
"Paid" Isn't the Same as "Paid Correc...
When a claim comes back paid, the workflow closes. The case moves out of the queue. Someone marks it resolved. The prob...
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June 05, 2026
Revenue Integrity in Healthcare: The ...
Revenue is disappearing long before denials ever hit a ledger. Hospitals and health systems still rely heavily on retros...
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June 03, 2026
RiskGen-i & Risk Adjustment in 2026: ...
In 2026, Medicare Advantage risk adjustment is no longer just a coding exercise. It has become a high-stakes operational...
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