Revenue Cycle & Payment Integrity
Expert articles and analysis related to revenue cycle & payment integrity.
AI Summary — Last 7 Days
Payment integrity pressure is intensifying around Medicare Advantage risk adjustment, with KFF detailing how coding intensity continues to inflate plan payments and CRFB arguing the Saving MEDICARE Act would materially reduce MA overpayments—signals that MA coding, RADV enforcement, and benchmark accuracy remain central targets under CMS payment reform scrutiny. For VBC stakeholders, the same dynamic is spreading beyond MA into delivery models: commentary from Aledade frames ACO-style longitudinal primary care as a fraud/waste detection tool, while debate over CMS’s WISeR prior-authorization demonstration and AI contractor oversight underscores the tension between using technology to curb unnecessary spending and protecting access, provider burden, and model trust. KFF on MA coding intensity | Aledade on VBC and fraud prevention
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Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS,...
Medicare fraud: How value-based care helps identify and prevent waste
Medicare fraud: How value-based care helps identify and prevent waste Aledade
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Saving MEDICARE Act Would Dramatically Reduce MA Overpayments-2026-07-02
Saving MEDICARE Act Would Dramatically Reduce MA Overpayments-2026-07-02 Committee for a Responsible Federal Budget
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