Payment Integrity & Revenue Cycle
Expert articles and analysis related to payment integrity & revenue cycle.
AI Summary â Last 24 Hours
Payment integrity pressure is intensifying across Medicare Advantage and other taxpayer-funded programs: Monogram Health agreed to pay $2.4 million to resolve False Claims Act allegations tied to unsupported MA diagnosis codes, while DOJ launched a National Fraud Detection Center to use data analytics against fraud in federal programsâraising the stakes for risk adjustment, documentation, and vendor oversight in VBC models. At the same time, CMS is tightening prior authorization transparency requirements for MA, Medicaid managed care, and ACA marketplace plans, increasing operational pressure on payers and delegated entities to expose denial and timing patterns that affect access, revenue cycle performance, and provider-plan contracting (HFMA on CMS prior authorization transparency; DOJ fraud detection center).
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