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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.

Preparing for CLFS Reimbursement Changes: Why...

Laboratory revenue cycle management encompasses every operational process connecting clinical laboratory services to collected Medicare reimbursement – and in August 2026, it has become the most actionable lever available to laboratory executives preparing for a confirmed payment shift. The Consolidated Appropriations Act, 2026, signed February 3, 2026, delayed all PAMA-related Clinical Laboratory Fee Schedule (CLFS) rate reductions through December 31, 2026 – the seventh Congressional intervention since PAMA was enacted [1]. But the reprieve is temporary.

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Laboratory revenue cycle management review of billing accuracy, denials, reimbursement trends, and 2027 CLFS readiness
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documentation to code integrity medical coding services audit exposure 2026 CMS improper payments U.S. healthcare providers specialty
September 10, 2026

Most Healthcare Audit Exposure Doesn'...

Most of what gets called a coding problem is not a coding problem. It is a documentation problem that surfaces in the co...

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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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ambulatory surgical center billing ASC medical billing ASC medical coding 2026
August 06, 2026

Why Ambulatory Surgical Center Billin...

Ambulatory Surgery Centers (ASCs) are one of the fastest-growing segments of U.S. healthcare. Advances in minimally inva...

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ACO risk adjustment MSSP 2027 CMS proposed rule benchmark ACO REACH risk adjustment solutions revenue cycle
August 01, 2026

What CMS's July 14 Proposed Rule Mean...

CMS's proposed rule arrives against a backdrop of sustained program success and measurable improvements over time....

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physician billing services 2026 Medicare physician fee schedule conversion
July 22, 2026

The 2026 Medicare Physician Fee Sched...

CMS finalized the 2026 Medicare Physician Fee Schedule (MPFS) in October 2025, with policies effective January 1, 2026. ...

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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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physician coding mistakes payer denials medical billing 2026
June 19, 2026

Top 7 Physician Coding Mistakes Trigg...

Why is physician coding creating more revenue risk in 2026? Physician coding is no longer just a compliance function sit...

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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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