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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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DME Billing
December 12, 2024

Urinary Catheter Fraud Is Impacting A...

If your billing department handles durable medical equipment (DME), you should stay tuned in to the actions of the Cente...

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Market-based logistics efficiency
September 19, 2023

Home Health Billing Fraud Study Sheds...

Providers who outsource home health billing see multiple benefits, but one of the most important is access to a tool in ...

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Market-based logistics efficiency
September 12, 2023

Changed Your Service Lines? It's Time...

In the wake of COVID, budget crunches, and labor shortages, many hospitals and health systems have been making the smart...

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Risk Adjustment Coding Strategy
June 15, 2021

Home Health Billing Impact: Home Infu...

Medical billing has seen multiple changes because of the COVID-19 pandemic. We’ve covered the Hospital at Home and its p...

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