Revenue Cycle Integrity
Expert articles and analysis related to revenue cycle integrity.
AI Summary — Last 30 Days
Revenue cycle integrity is becoming a core VBC operating issue as CMS payment innovation, MA risk adjustment scrutiny, and denial-management pressure converge: CMS’s 10-year ACCESS model has drawn more than 150 applicants, signaling continued provider appetite for prospective, accountability-based payment despite tighter expectations around documentation, coding, and measurable performance (Medical Economics). At the same time, DOJ activity, MA false-claims settlements, and reporting on aggressive risk-assessment tactics are pushing plans, ACOs, and enablement vendors toward audit-ready clinical documentation integrity and
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AI can improve patient access, coding, billing, and payment, but CFOs need a revenue cycle operating model built for scale, trust, and governance. The post 4 shifts that define the revenue cycle of th...
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Revenue Cycle NOW: How Inova and Providence Are Automating the Front End
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The big mistake health systems make in revenue cycle tech contracts
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In one health care organization, a provider was reviewed and cleared through routine payment integrity processes. Months later, that same provider became the subject of a fraud investigation, based on...
The hidden $1.1B fraud threat in physician lab referrals
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Aetna agreed to pay $117.7 million in Medicare Advantage false claims settlement
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