As landmark industry and regulatory trends such as the Trusted Exchange Framework and Common Agreement (TEFCA)…
Category: News
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…
3 updates from the 2026 CMS Final Rate Announcement
The Centers for Medicare & Medicaid Services (CMS) has released the Final Medicare Advantage (MA) and…
Payment integrity: Unlocking the value of complex outpatient reviews
With U.S. healthcare spending projected to exceed $5.3 trillion in 2025, payers are under more pressure…