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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.

Modifier 59: Why $4.4 Million in Podiatry Bil...

Podiatry billing services for foot and ankle surgery require a level of modifier precision that standard automated billing systems are not built to deliver – and the consequences of getting it wrong are measurable. OIG's December 2025 audit of podiatrists' Medicare claims found that 49 of 100 sampled claims did not comply with Medicare requirements, projecting approximately $4.4 million in improper payments across the full claim population [1].

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Podiatry coding review for Modifier 59 and XS documentation accuracy in multi-procedure foot and ankle surgery claims
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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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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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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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HCC risk adjustment coding Medicare Advantage
July 07, 2026

Why HCC Risk Adjustment Coding Is a B...

Two things converged in 2026 that make HCC risk adjustment coding a more consequential financial function than it has ev...

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prospective concurrent retrospective risk adjustment 2026 guide MA plans ACOs
June 22, 2026

Prospective, Concurrent, and Retrospe...

Risk adjustment is often discussed as a Medicare Advantage problem. In actuality, it affects every organization whose re...

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HCC risk adjustment coding defensible Medicare Advantage RADV
June 12, 2026

The New Era of HCC Risk Adjustment: W...

For years, many Medicare Advantage organizations treated HCC risk adjustment as a volume exercise: capture more diagnose...

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outsourcing medical billing healthcare accounts receivable management revenue cycle 2026
June 10, 2026

Outsourcing Medical Billing for Healt...

Most healthcare organizations don't decide to outsource medical billing because of a single crisis. The decision builds ...

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OIG Medicare Advantage HCC risk adjustment coding audit 2026
June 07, 2026

OIG Flags $462 Million in Medicare Ad...

On June 1, 2026, the HHS Office of Inspector General published one of the most significant Medicare HCC risk adjustment ...

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underpayment revenue leakage medical billing
June 06, 2026

"Paid" Isn't the Same as "Paid Correc...

When a claim comes back paid, the workflow closes. The case moves out of the queue. Someone marks it resolved. The prob...

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