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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.

Two Settlements. $674 Million. What the 2026 ...

For most of the past decade, Medicare Advantage risk adjustment compliance was understood primarily through the lens of RADV audits – CMS's program for reviewing a sample of submitted diagnosis codes against the underlying medical records. A RADV finding could result in recoupment, adjustments, and operational scrutiny. Significant, but manageable.

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RADV audits Medicare risk adjustment 2026 FCA settlements Kaiser Aetna OIG enforcement risk adjustment
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medical coding outsourcing services AI human expertise denial prevention 2026
August 18, 2026

Why AI Alone Isn't Solving the Medica...

Healthcare organizations across the United States continue facing compounding pressure from denial volumes, administrati...

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ambulatory surgical center billing ASC medical billing ASC medical coding 2026
August 06, 2026

Why Ambulatory Surgical Center Billin...

Ambulatory Surgery Centers (ASCs) are one of the fastest-growing segments of U.S. healthcare. Advances in minimally inva...

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ACO risk adjustment MSSP 2027 CMS proposed rule benchmark ACO REACH risk adjustment solutions revenue cycle
August 01, 2026

What CMS's July 14 Proposed Rule Mean...

CMS's proposed rule arrives against a backdrop of sustained program success....

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accounts receivable services 2026 accounts receivable management services AR discipline hospital
July 31, 2026

Increasing Revenue Leakage Calls for ...

Sometimes in healthcare, times emerge when status quo approaches to revenue cycle strategy are no longer enough. This ti...

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orthopedic billing services PE-backed practice EBITDA revenue cycle medical billing
July 28, 2026

Why Orthopedic Billing Accuracy Is a ...

Orthopedic billing services are the specialized revenue cycle functions that manage claim submission, coding accuracy, p...

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physician billing services 2026 Medicare physician fee schedule conversion
July 22, 2026

The 2026 Medicare Physician Fee Sched...

CMS finalized the 2026 Medicare Physician Fee Schedule (MPFS) in October 2025, with policies effective January 1, 2026. ...

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McKinsey survey medical billing services USA outsource revenue cycle management
July 20, 2026

McKinsey Survey Highlights Reasons to...

As the healthcare landscape shifts, revenue cycle leaders face increasing pressure to answer tough strategic questions. ...

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laboratory revenue cycle management clinical lab billing services pathology billing services
July 17, 2026

What the 2026 OIG Lab Spending Data M...

For clinical laboratory and pathology executives, 2026 presents a reimbursement landscape that looks fundamentally diffe...

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outsourcing medical billing services cash flow US healthcare 2026
July 13, 2026

Clean Claim Strategies in 2026: How S...

In 2026, outsourcing medical billing and clean claim strategy are converging into a single financial priority for U.S. h...

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