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Rethinking Risk Coding in 2025: Why Commercial Plans Are Redefining the HIM Playbook
Risk-adjusted payment is no longer just a Medicare Advantage concern—commercial insurers are reshaping how coding, documentation, and compliance strategies must evolve.
CMS Launches Aggressive Medicare Advantage Audit Strategy: What Providers Must Know
This move carries major implications for Medicare Advantage organizations, providers, and Health Information Management (HIM) professionals..webp)
CMS Proposes Major Overhaul to Readmission Penalties: What HIM Professionals Must Know
CMS is proposing five major changes that will significantly affect hospitals' readmission management strategies, requiring essential adjustments to prevent readmissions..webp)
Medicare Administrative Contractors: Oversight Shortfalls and Appeals System Flaws
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently published a critical audit report highlighting major compliance failures among Medicare Administrative Contractors..webp)
Wound Care Under Scrutiny: How to Protect Your Practice from Medicare Audits
From expert billing strategies to fraud mitigation and appeals guidance, this guide offers everything you need to stay compliant and confident..webp)