10 Common Fee-for-Service Coding Denials and How to Prevent Them in 2026
Why Are Fee-for-Service Coding Denials the Biggest Source of Revenue Loss in 2026? Most of your lost FFS revenue is not caused by underpayment; it is caused by preventable coding denials. Across U.S. healthcare, 10–15% of fee-for-service claims are denied on first pass, and 20–49% of those denials are driven by coding and documentation errors, […]
wRVU-Based Compensation and Adjusting Contracts for 2026 Changes
What You Need to Know About wRVU-Based Compensation and Adjusting Contracts for 2026 Changes Right Now? If your organization uses wRVU-based physician compensation, your contracts are about to become financially inaccurate on January 1, 2026. CMS has finalized a –2.5% efficiency adjustment to work RVUs for nearly all non-time-based CPT codes, including procedures, imaging, diagnostics, […]
AI Isn’t Replacing Us. It’s Partnering With Us. Welcome to Collaborative Compliance in 2026.
Healthcare leaders are asking a very real question in 2026: Is AI increasing compliance risk, or redefining how we manage it responsibly? Here’s the short answer, up front: AI is not replacing clinical, coding, or financial judgment. It is amplifying it when humans stay in the loop. An AI coding tool suggests a diagnosis that […]
Advance Care Planning (ACP): An Underused Service for Medicare Beneficiaries That Matters, Clinically and Operationally
Advance Care Planning (ACP) is one of the clearest examples of high-value clinical work that consistently goes undercaptured in Medicare billing. Despite being covered, reimbursable, and strongly aligned with quality and patient-centered care goals, CPT® codes 99497 and 99498 remain significantly underutilized across primary care and specialty settings. If you oversee clinical documentation integrity (CDI), […]
Best Practices in Clinical Documentation 2026 for Health Systems
What Does Best Practice Clinical Documentation Look Like for Health Systems in 2026? Clinical documentation in 2026 is no longer an operational afterthought; it is a strategic control point for patient safety, reimbursement protection, audit resilience, and organizational performance. The short answer to what “best practice” means in 2026: Health systems must shift from retrospective, […]
5 Signs Your CDI Program Needs Improvement and When to Seek External Support
How Do You Know When Your CDI Program Is No Longer Delivering Results? Your CDI program needs improvement when it no longer moves core outcome metrics CMI, denials, audit risk, provider engagement, and financial integrity, despite ongoing effort. When those gaps persist or widen, external CDI support becomes a strategic necessity, not a last resort. […]
HEDIS Reporting and Documentation Last Minute Gaps That Impact Quality Scores
Why Do Last-Minute HEDIS Documentation Gaps Still Derail Quality Scores? If you’re leading CDI, HIM, or Revenue Cycle today, you already know the uncomfortable truth: most HEDIS failures don’t occur because care wasn’t delivered; they occur because it wasn’t documented, coded, or linked correctly in time. Each measurement year, healthcare organizations face the same pattern. […]
AI in Revenue Cycle Management: What’s Actually Working vs. What’s the Hype for 2026
Is AI in Revenue Cycle Management Delivering Real ROI or Just Hype for 2026? Artificial intelligence hit peak hype in healthcare this 2026. Every startup claims to be “AI-powered,” legacy vendors tout “AI suites,” and machine learning is pitched as the silver bullet for Revenue Cycle Management (RCM). The reality? Some capabilities are proven and […]
7 High-Impact Payer Reimbursement Policy Decisions Influencing Claims, Audits & Cash Flow in 2026
Why do 2026 payer reimbursement policies matter right now? If you lead Clinical Documentation Integrity (CDI), HIM, Revenue Cycle, or Finance, here’s the reality you’re already feeling: payer reimbursement policy is no longer just a compliance issue, it’s a cash flow strategy. In 2026, major commercial and Medicare Advantage payers are tightening medical necessity definitions, […]
RADV Audit Risk Surge November 2025 Data Shows 30 % Increase
Why Are RADV Audits Surging by 30% in Late 2025? In November 2025, healthcare leaders are facing a significant surge in risk adjustment data validation (RADV) audit activity, approximately 30 % more notices, requests, and regulatory pressure compared with early 2025 baselines. This escalation reflects a systemic shift from occasional, targeted reviews to routine, comprehensive […]