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Insights That Move Healthcare

Expert perspectives on revenue cycle, risk adjustment, compliance, and healthcare strategy – designed to help providers, plans, and leaders make smarter operational and financial decisions.

Understanding the Impact of the CMS-HCC Phase...

Risk adjustment services for Medicare Advantage organizations are now operating in a materially different environment. The three-year phase-in of the 2024 CMS-HCC (V28) risk adjustment model is complete – meaning 100% of risk scores for non-PACE Medicare Advantage organizations are now calculated under the updated model [1].

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Medical coding audit and CPT 2027 readiness review covering AI and maternity coding changes
October 16, 2026

Medical Coding Services in Transition...

Medical coding services teams are managing two priorities as 2026 moves into its final quarter: confirming that CPT chan...

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denial management services 2027 clean claim checks eligibility authorization coding audit payer-specific workflows
October 12, 2026

10 Denial Management Strategies Healt...

Denial management services – the operational processes that prevent, track, appeal, and analyze payer claim rejections a...

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home health billing companies AI governance human oversight documentation coding accuracy 2027
October 08, 2026

AI in Home Health Billing: What Healt...

Home health billing – the operational process of coding, documenting, submitting, and collecting reimbursement for home ...

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Medicare Advantage accounts receivable and risk adjustment teams reviewing RAF, RADV, and encounter documentation
October 06, 2026

CMS Proposed Changes to 2027 Medicare...

Medicare Advantage (MA) revenue for 2027 is being pushed toward a higher standard of proof, and revenue cycle leaders wi...

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Medical coding audit reviewing FY 2027 diagnosis codes, documentation, and EHR updates
October 01, 2026

ICD-10-CM FY 2027 Is Live: What Medic...

Medical coding services teams entered a new coding environment on October 1, 2026, when the FY 2027 ICD-10-CM update too...

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Podiatry coding review for Modifier 59 and XS documentation accuracy in multi-procedure foot and ankle surgery claims
September 30, 2026

Modifier 59: Why $4.4 Million in Podi...

Podiatry billing services for foot and ankle surgery require a level of modifier precision that standard automated billi...

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Payer-specific hospital denial prevention priorities for Medicare, Medicaid, and private insurance
September 24, 2026

Hospital Denial Management: Prioritiz...

Hospital revenue cycle teams often track denials by volume, payer, reason code, and aging. But effective denial manageme...

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Laboratory revenue cycle management review of billing accuracy, denials, reimbursement trends, and 2027 CLFS readiness
September 18, 2026

Preparing for CLFS Reimbursement Chan...

Laboratory revenue cycle management encompasses every operational process connecting clinical laboratory services to col...

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Home health billing workflow review for PDGM, OASIS documentation, LUPA monitoring, and Medicare reimbursement accuracy
September 16, 2026

Why the 2027 Medicare Payment Proposa...

CMS has proposed a 2.4% Medicare payment increase for home health providers in 2027, offering some financial relief afte...

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