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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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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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risk adjustment coding companies
May 05, 2026

Risk Adjustment & HEDIS in 2026: Why ...

In 2026, health plans, Medicare Advantage organizations, and risk adjustment coding companies across the US face growing...

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Risk Adjustment Medical Coding
June 06, 2025

The 2026 Medicare Advantage Final Rul...

The Centers for Medicare & Medicaid Services' (CMS) CY 2026 Rate Announcement introduces significant updates that direct...

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Accurate HCC Risk Adjustment
May 16, 2025

How Accurate HCC Risk Adjustment Can ...

As the healthcare industry continues to shift toward value-based care, precise Hierarchical Condition Category (HCC) ris...

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