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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 audits RADV payment years 2020 2021 2024 risk adjustment solutions documentation review
October 20, 2026

Understanding the Impact of the CMS-H...

Risk adjustment services for Medicare Advantage organizations are now operating in a materially different environment. T...

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

Could HCC Risk Adjustment Have Preven...

HCC risk adjustment became the center of a $14.1 million Department of Justice settlement on August 3, 2026, when Comple...

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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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