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
We’ve assembled the latest news for healthcare revenue cycle leaders to help you stay on top of industry challenges and adapt your revenue cycle management services to the challenges of USA medical billing.
CMS has issued a proposed rule intended to close a loophole in Medicaid
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
As the healthcare industry continues to shift toward value-based care, precise Hierarchical Condition Category (HCC) risk adjustment is more important than ever for organizations aiming to optimize reimbursements. The 2025 CMS risk model updates will demand enhanced precision, adaptability, and compliance. To thrive, healthcare organizations must prioritize accuracy
For revenue cycle leaders, maintaining compliance while minimizing financial risk is an ongoing challenge. As healthcare entities continue to see increasing risk from changes to government policies, shifting patient demographics, and shrinking margins, risk management will become an increasingly essential focus for survival. One of the most effective tools for achieving risk management goals is examining the application of Comprehensive Error Rate Testing (CERT) and how it impacts organizations that deal
