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 […]
31 % of Coding Staff Consider Leaving What Healthcare Systems Are Doing to Retain Talent
If you lead HIM or the revenue cycle, you’re already feeling the pressure: rising workloads, widening talent gaps, and increasingly unstable staffing pipelines. The headline number, 31% of healthcare workers considering leaving, comes from a McKinsey & Company survey on the nursing workforce, where nearly one-third of nurses reported an intent to leave direct patient […]
10 CDI Leaders Share Best Practices for Concurrent Review Implementation
Why Concurrent Review Implementation is Crucial? Concurrent Review has become one of the most critical levers for strengthening Clinical Documentation Integrity (CDI) programs in 2026. As payer scrutiny intensifies, denial rates rise, and quality outcomes directly influence reimbursement, CDI leaders like you, HIM Directors, CDI Directors, and VPs of Revenue Cycle, are asking one core […]
6 Steps to Prepare for the CMS HCC Model V28 – 2026
Understanding the 2026 V28 Cliff In 2026, the Centers for Medicare & Medicaid Services (CMS) will finalize the three-year transition to the V28 risk adjustment model, ending the era of blended V24/V28 scoring. For Payment Year (PY) 2026, 100% of RAF scoring will be based on V28, meaning V24 codes will disappear overnight from reimbursement […]
One Misstep. One Service Line. $11.7Million Lost. Why 100% AWV Coding Review Is Non-Negotiable
Why Penn State Health Paid a Penalty? Penn State Health (PSH) recently paid over $11.7 million to resolve voluntarily self-disclosed violations related to Medicare claims for Annual Wellness Visit (AWV) services. The settlement serves as a stark reminder: even well-intentioned healthcare organizations can face devastating financial consequences when AWV documentation and coding fall short of […]
When “More” Doesn’t Mean “Moderate”
When “More” Doesn’t Mean “Moderate” Understanding the Acute Problem Riddle in MDM. Let’s be honest — it makes sense to assume that if a patient shows up with four acute problems, the visit should reflect a higher level of complexity. After all, managing multiple complaints takes more time, focus, and decision-making, right? That’s where the […]
A Time to Reflect & Look Ahead
In American corporate culture, the final week of the year often serves as a time for reflection and big-picture thinking. At Chirok, we take this opportunity to review all our decisions through the lens of our core value: improving revenue cycle performance according to each client’s unique definition of success.
Luddites, Nurse Practitioners, and Driverless Cars Inform the Impact of AI on Healthcare
The arrival of artificial intelligence (AI) in healthcare raises pressing questions about the future of the healthcare workforce, professional guilds, and industry-wide best-practice. What lessons can we glean from history to better understand the opportunities and risks?
Evaluating the role of AI in value based care premium adjustment
This study aims to understand the ways in which augmenting AI with clinical reviewers can unlock faster adoption, increase efficiency, and improve compliance in the HCC coding process. Probing the relative benefit of AI versus augmenting with service-based solutions is especially relevant.