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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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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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