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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.

Prospective, Concurrent, and Retrospective Ri...

Risk adjustment is often discussed as a Medicare Advantage problem. In actuality, it affects every organization whose reimbursement, shared savings, or quality performance depends on accurately reflecting the complexity of their patient population.

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prospective concurrent retrospective risk adjustment 2026 guide MA plans ACOs
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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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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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medical billing audit services
June 05, 2026

Revenue Integrity in Healthcare: The ...

Revenue is disappearing long before denials ever hit a ledger. Hospitals and health systems still rely heavily on retros...

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medical coding audit
May 22, 2026

Why Your 99214 Keeps Becoming a 99213...

You’re leaving $25-$40 per visit on the table every time a legitimate 99214 gets downcoded to 99213. Not because someone...

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Accounts Receivable
February 19, 2026

Why 2026 Is the Year Practices Must R...

For U.S. healthcare providers, 2026 represents a genuine inflection point for accounts receivable (AR) – driven by sever...

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Market-based logistics efficiency
January 12, 2026

Home Health Quality Reporting & OASIS...

As Home Health Agencies (HHAs) move into 2026, the finalized CMS CY 2026 Home Health Prospective Payment System (HH PPS)...

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Healthcare Revenue Cycle Management
October 14, 2025

How to Modernize Your Healthcare Reve...

Healthcare organizations face constant pressure: rising medical billing denials, delayed reimbursements, evolving regula...

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medical billing best practices
September 19, 2025

7 Best Practices for Medical Billing ...

If you’re a U.S. healthcare provider searching for medical billing and coding services, you’re not alone. Thousands of p...

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Medical Coding Audit
July 08, 2025

Medical Coding Audits 101: How Physic...

You’re wrapping up a 10-hour shift. One more note to finish, one last patient to call – and then someone from billing wa...

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