Risk Adjustment Data Validation (RADV) Audits: Turning Compliance into Competitive Advantage
In this article we break down what makes Risk Adjustment Data Validation (RADV) audits so challenging, what’s changing, and how health plans can flip the script from reactive compliance to proactive strategy.
CPT® PLA Code Changes for October 2025: Key Changes for Providers and Billing Teams
As of October 1, 2025, the American Medical Association (AMA) CPT® Editorial Panel has released its latest set of Proprietary Laboratory Analyses (PLA) code changes. The update includes 25 new PLA codes, two deletions, and one revision.
Aetna’s New Payment Policy: A Challenge to Hospitals and the Two-Midnight Rule
In November 2025, Aetna announced a major shift in its inpatient admission payment policy that could have significant financial consequences for hospitals. While the change appears to simplify approvals under the Two-Midnight Rule, it introduces hidden risks that may lead to reduced payments and eliminate hospitals’ rights to appeal.
Healthcare Policy Changes in 2025 and Beyond: What Providers Need to Know to Stay Ahead
The healthcare policy landscape in 2025 is transforming, affecting reimbursement models, telehealth expansion, and patient access rights. For providers, staying informed and proactive is not options - it's essential for financial stability and regulatory compliance.
Staying Compliant: A Deep Dive into CMS Q4 2025 HCPCS Code Changes
On August 21, 2025, the Centers for Medicare & Medicaid Services (CMS) released its fourth quarter update to the HCPCS Level II code set. This update impacts a wide range of healthcare providers who report services, supplies, drugs, and equipment.