Revenue Cycle Integrity

Provider groups are escalating pressure on Congress and CMS over revenue cycle friction points that directly affect VBC performance: ACP is urging a pause on payer use of AI in prior authorization, while AMGA is pressing for reduced administrative waste and DMEPOS documentation burdens that can delay care, inflate operating costs, and undermine ACO care management workflows (ACP prior authorization AI, AMGA administrative complexity brief). The immediate tension for Medicare Advantage plans, ACOs, and risk-bearing provider groups is whether automation and documentation controls can protect program integrity without worsening denials, leakage, delayed post-acute/DME access, and clinician burden—especially as DOJ fraud data activity keeps payment integrity scrutiny high.