UnitedHealth faces structural margin compression, wage inflation, and regulatory headwinds, eroding its historical defensive ...

On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced a significant expansion of its auditing ...

On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced plans to substantially increase both the pace and the scale of ...

Health insurers are on alert after the Centers for Medicare & Medicaid Services announced May 22 that it is immediately ...

On May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) announced significant changes in its risk adjustment data ...

CMS will hire nearly 2,000 coders to conduct audits to confirm diagnoses used for payment are backed by medical records.

Last week, I was flipping through the newly filed financial documents of AdventHealth, and the numbers hit me like an ...

New rules ignite a surge in payer demand for data platforms that support RADV readiness, Stars forecasting, and member ...

On November 24, 2020, the Department of Health and Human Services (HHS) issued a final rule to amend the Affordable Care Act’s (ACA’s) risk adjustment data validation (RADV) program.

Risk Adjustment Data Validation (RADV) audits are CMS’s primary means of policing risk adjustment. RADV audits seek to ensure the integrity of the MA program by identifying improper risk ...