The healthcare industry is on the cusp of a significant transformation with the shift to digital…
Category: News
eBook: How to evolve your FWA program in 2025
Fraud, waste, and abuse (FWA) in healthcare can lead to substantial cost increases and negatively impact…
eBook: Driving business value through interoperability
As landmark industry and regulatory trends such as the Trusted Exchange Framework and Common Agreement (TEFCA)…
NCQA releases proposed HEDIS MY 2026 updates
Each year, NCQA publishes a list of measure updates, additions, and deletions for future HEDIS® measurement…
White Paper: Preparing for success in Medicare Advantage risk adjustment
Risk adjustment is a crucial component of Medicare Advantage (MA), ensuring that payments to MA plans…
FWA Insights: Reducing audit abrasion
Fraud, waste, and abuse (FWA) audits play a crucial role in ensuring healthcare payment integrity by…
Webinar: Confronting payment integrity challenges in 2025
Keeping pace with the constant updates to HCPCS codes, CPT codes, and both local and national…
Busted: The top healthcare fraud schemes of Q4 2024
As 2024 came to a close, significant cases of fraud, waste, and abuse (FWA) in the…
Case study: The value of cross-payer analytics
As payers continue to be plagued by rising medical loss ratios (MLR) and seek to control…
FWA Insights: Skin grafts and substitutes
Fraud, waste, and abuse (FWA) in healthcare can lead to significant financial losses and compromised patient…