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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.

Most Healthcare Audit Exposure Doesn't Start ...

Most of what gets called a coding problem is not a coding problem. It is a documentation problem that surfaces in the coding function – months after the clinical encounter, long after the physician has moved on, usually right before an audit.

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documentation to code integrity medical coding services audit exposure 2026 CMS improper payments U.S. healthcare providers specialty
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orthopedic billing services 2026 revenue leakage denial patterns prior authorization medical billing
September 08, 2026

Orthopedic Revenue Leakage in 2026: T...

In 2026, orthopedic revenue leakage is becoming a growing financial concern for healthcare organizations across the Unit...

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HCC risk adjustment risk adjustment services risk adjustment coding companies Medicare Advantage False Claims
September 04, 2026

Could HCC Risk Adjustment Have Preven...

Could HCC Risk Adjustment Have Prevented the $14M Complete Health Settlement?...

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pediatric billing services 2026 CPT codes 90482 90483 90484 vaccine counseling developmental
August 31, 2026

Pediatric Coding Complexity in 2026: ...

In 2026, keeping up with pediatric coding updates has become a top priority for U.S. healthcare organizations. Specializ...

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gastroenterology billing services screening diagnostic colonoscopy conversion modifier PT 2026
August 28, 2026

How Screening-to-Diagnostic Colonosco...

In 2026, screening-to-diagnostic colonoscopy conversions remain one of the most overlooked reimbursement risks for gastr...

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home health billing companies Medicare fraud Collins bill 2026 home health coding billing
August 26, 2026

Collins Introduces Bill to Prevent Me...

Home health billing companies and revenue cycle leaders in home health settings are navigating a rapidly tightening enfo...

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RADV audits Medicare risk adjustment 2026 FCA settlements Kaiser Aetna OIG enforcement risk adjustment
August 21, 2026

Two Settlements. $674 Million. What t...

For most of the past decade, Medicare Advantage risk adjustment compliance was understood primarily through the lens of ...

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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 and measurable improvements over time....

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