HCC risk adjustment in 2025 is more than just a compliance checkbox – it’s a strategic driver of revenue and regulatory resilience. With the Centers for Medicare & Medicaid Services’ (CMS) hybrid model blending the 2020 and 2024 HCC frameworks, risk adjustment medical coders, compliance teams, and clinical leaders are navigating a landscape where outdated codes vanish, specificity is king, and audits loom large.
But with the right tools and techniques, this complexity becomes opportunity.
The Centers for Medicare & Medicaid Services’ (CMS) CY 2026 Rate Announcement introduces significant updates that directly impact medical coding risk adjustment, revenue cycle operations, and overall reimbursement strategy. As healthcare leaders evaluate their prospective risk adjustment strategies in light of these changes, understanding the
The healthcare revenue cycle is undergoing significant transformation, driven by evolving regulations, shifting payer policies, and increasing administrative burdens. For revenue cycle leaders, these changes present both challenges and opportunities, especially in optimizing medical billing accuracy and choosing a medical billing outsourcing company partner.
With the current administration promising more deregulation in
Imagine this: A routine payer audit uncovers $250,000 in penalties – all due to overlooked coding errors and cloned notes. For many U.S. healthcare providers, this scenario is all too real. But with a proactive medical coding audit strategy, it doesn’t have to be. This blog explores how a strategic triad of coding audits, clinical documentation reviews, and
The medical billing outsourcing market is experiencing unprecedented growth, with the global market size projected to reach $54.17 billion by 2034, growing at a compound annual growth rate (CAGR) of 12% from 2025 to 2034 [1]. For healthcare providers, the decision to outsource medical billing is no longer just about cost reduction – it’s a strategic move that drives higher revenue, ensures compliance, and improves operational efficiency. This guide explores the benefits, trends, and implementation
