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.

Why is physician coding creating more revenue risk in 2026? Physician coding is no longer just a compliance function sit...
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On May 13, 2026, the Centers for Medicare and Medicaid Services imposed an unprecedented nationwide six-month moratorium...
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For years, many Medicare Advantage organizations treated HCC risk adjustment as a volume exercise: capture more diagnose...
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In 2025, U.S. hospitals spent $18 billion overturning claims denials. Not losing those claims. Not writing them off. Ov...
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On June 1, 2026, the HHS Office of Inspector General published one of the most significant Medicare HCC risk adjustment ...
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In 2026, Medicare Advantage risk adjustment is no longer just a coding exercise. It has become a high-stakes operational...
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The PAMA reporting window for clinical laboratories is open right now – May 1 through July 31, 2026. What applicable lab...
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Remote Patient Monitoring (RPM) billing sounds like one of those healthcare ideas that should be simple: Patients stay h...
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You’re leaving $25-$40 per visit on the table every time a legitimate 99214 gets downcoded to 99213. Not because someone...
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