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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.

Risk Adjustment Solutions for 2027: Moving fr...

Risk adjustment solutions for Medicare Advantage organizations are entering 2027 under a confirmed payment environment and a set of operational changes that require adaptation before January 1. CMS's April 2026 Rate Announcement projects MA payments to increase by 2.48% – over $13 billion – in CY 2027, while CMS expects MA risk scores to increase by 2.50% on average due to underlying coding trends [1]

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risk adjustment companies risk adjustment audits unlinked CRR exclusion 2027 chart review services
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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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documentation to code integrity medical coding services audit exposure 2026 CMS improper payments U.S. healthcare providers specialty
September 10, 2026

Most Healthcare Audit Exposure Doesn'...

Most of what gets called a coding problem is not a coding problem. It is a documentation problem that surfaces in the co...

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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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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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