Rural health news has been increasingly unpredictable in recent years. At the announcement of the One Big Beautiful Bill, experts predicted dire consequences for rural health and the threat of pushing hundreds of struggling hospitals closer to a fiscal cliff. Soon after, promises of the $50 billion Rural Health Transformation Program signaled an opportunity
Risk adjustment audits are changing again, and leaders in charge of risk adjustment services should take note as the implications are massive.
In October 2025, a federal court struck down the Biden administration’s 2023 Risk Adjustment Data Validation (RADV) audit overhaul, unraveling a key regulation that would have significantly expanded Medicare Advantage (MA) plan audit recoveries. For payers, providers, and revenue cycle leaders managing risk adjustment operations, this decision adds a fresh layer of uncertainty – but also
With telehealth now a mainstream mode of care, many pathology labs, clinical laboratories, and behavioral health providers are asking: Can urine toxicology testing be billed separately from a telehealth E/M (evaluation and management) visit performed on the same date?
In 2025, as payers tighten claim edits and deploy AI-driven audits, the answer isn’t always straightforward. Accurate pathology billing services and compliant laboratory revenue cycle management (lab RCM) workflows are now critical for
Accuracy gets all the attention in risk adjustment coding, and rightly so. It’s the backbone of compliance, reimbursement, and audit defense.
But here’s the truth: accuracy alone doesn’t keep your revenue cycle moving – productivity does.
That’s where many healthcare organizations and risk adjustment coding
