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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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home health billing companies AI governance human oversight documentation coding accuracy 2027
October 08, 2026

AI in Home Health Billing: What Healt...

Home health billing – the operational process of coding, documenting, submitting, and collecting reimbursement for home ...

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Medicare Advantage accounts receivable and risk adjustment teams reviewing RAF, RADV, and encounter documentation
October 06, 2026

CMS Proposed Changes to 2027 Medicare...

Medicare Advantage (MA) revenue for 2027 is being pushed toward a higher standard of proof, and revenue cycle leaders wi...

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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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Laboratory revenue cycle management review of billing accuracy, denials, reimbursement trends, and 2027 CLFS readiness
September 18, 2026

Preparing for CLFS Reimbursement Chan...

Laboratory revenue cycle management encompasses every operational process connecting clinical laboratory services to col...

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FQHC billing team reviewing 2026 CMS coding changes, claim performance, and revenue cycle management requirements
September 15, 2026

FQHC Billing and Reimbursement: What ...

FQHC billing services in 2026 are operating under a materially updated payment and coding environment – one that affects...

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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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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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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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