Revenue Cycle Integrity
Expert articles and analysis related to revenue cycle integrity.
AI Summary â Last 7 Days
Revenue cycle integrity is becoming a central VBC pressure point as Medicare Advantage scrutiny converges with provider pushback over denials, documentation, and payment delays: CarolinaEast Medical Center said it will exit two MA networks effective July 1 because UnitedHealthcare and BCBS MA policies have become âfinancially and operationally unsustainable,â while the AHA backed comprehensive MA reform amid broader concerns over prior authorization and reimbursement friction. At the same time, risk adjustment is shifting from growth lever to audit-liability domain, with new platforms positioning around MA audit readiness and clinical documentation integrity, fresh reporting on aggressive MA risk-assessment tactics, and Pearl Health arguing AI must improve accuracy and ethics in a roughly $50B risk-adjustment problem. Medicaid payment-model attention also widened through KFFâs analysis of the GENEROUS drug-pricing model, underscoring that savings will depend heavily on confidential
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CRUSHing Lab Fraud: Three Myths that Derail Real Reform
By JULIE EGGINGTON, EKATERINA CLEARY & LEEZA OSIPENKO When CMS issued its Request for Information under the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative in February, i...
Physician and his practice to pay $6.7M for allegedly performing unnecessary vascular procedures
<p>The physician was accused of pressuring Medicare patients into undergoing treatment they did not need. One patient allegedly received 42 different stents over an eight-year period.</p>
Accounts receivable days hide four billing problems
A cash symptom can have several causes A practice owner notices the same warning signs: collections are lower than expected, the bank balance feels tighter, and the billing report shows money still si...
5 keys to enhancing automation, expanding capacity and improving efficiency to reduce costs
Healthcare organizations in 2026 are operating under sustained financial strain. Margins remain compressed, workforce shortages continue, payer requirements are more complex and patient financial resp...
Three Affiliated Skilled Nursing Facilities to Pay $300,000 to Resolve False Claims Act Allegations Related to Medically Unnecessary Rehabilitation Services - Office of Inspector General (.gov)
Three Affiliated Skilled Nursing Facilities to Pay $300,000 to Resolve False Claims Act Allegations Related to Medically Unnecessary Rehabilitation Services  Office of Inspector General (.gov)
Respiratory Question for the Week of May 11, 2026
What are the coding and billing rules for ventilator use in the Emergency Department, including cases of patient transfer or expiration?
General Question for the Week of May 11, 2026
What should providers do when the administered drug dose does not match the total units in a single-dose container and no waste is documented?
HIMSSCast: âImplement an AI solution in digestible chunksâ
Joe Accurso, vice president of Revenue Cycle at Northwell Health Labs, has overseen the implementation of artificial intelligence in Northwellâs RCM that has created efficiencies and realized a 40% im...
Three Affiliated Skilled Nursing Facilities to Pay $300,000 to Resolve False Claims Act Allegations Related to Medically Unnecessary Rehabilitation Services - Department of Justice (.gov)
Three Affiliated Skilled Nursing Facilities to Pay $300,000 to Resolve False Claims Act Allegations Related to Medically Unnecessary Rehabilitation Services  Department of Justice (.gov)