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Proposed rule update for hospital leaders The Centers for Medicare & Medicaid Services (CMS) has proposed expanding five hospital 30-day Medicare Advantage mortality measures by adding eligible MA beneficiaries to existing cohorts. Medicare Advantage (MA) is the private-plan alternative to traditional Medicare. If finalized, MA data may influence quality measurement, hospital comparisons, and value-based purchasing…

Emergency department site of service must match the codes and data on every claim to avoid denials, recoupments, and audit exposure. A March 2026 report from the U.S. Department of Health and Human Services Office of Inspector General (OIG) found more than $15 million in improper and potentially improper Medicare payments tied to emergency department…

When extended downtime hits, the extended downtime revenue cycle plan must keep operations and cash moving. The immediate answer is stabilization: a workable continuity plan that captures documentation, routes work, tracks charges, continues coding and billing, maintains staff communication, and reconciles data when systems return. Extended downtime means normal technology like the electronic health record…

A signed order alone does not guarantee compliant payment for a laboratory testing panel. Medical necessity for laboratory panels is determined by the patient’s documented signs, symptoms, diagnoses, and clinical circumstances, and each component must be supported to be billable. If a panel includes tests that extend beyond the patient’s clinical need, those components are…

Yes—recurring medical necessity denials are largely preventable when front-end revenue cycle processes are built to catch payer requirements before care is delivered. Medical necessity denials occur when a payer rejects a claim because the documentation and clinical criteria do not support that the service was medically necessary under that payer’s policy. The fastest path to…

Coding education should change behavior, not just meet an annual requirement. When coding education—training on coding guidelines, documentation needs, and compliance—doesn’t reduce repeat errors or improve audit results, leaders need a different approach. The fastest way to move the numbers is to target education to audit findings, reinforce skills with real cases and timely feedback,…

If your cancer registry backlog is growing, the cost is real: accreditation exposure, delayed state and national submissions, weaker decision-making, and missed visibility into gaps in care. A cancer registry is the standardized system hospitals use to abstract and report cancer cases so leaders can track treatment patterns, outcomes, and compliance. When submissions fall behind,…

State AI laws in healthcare are moving fast, and the practical takeaway is clear: compliance and revenue cycle leaders should establish AI governance now to reduce exposure, avoid denial risk, and protect operations. Artificial intelligence (AI) refers to computational tools that automate tasks such as analysis and content generation. As states enact new AI restrictions…

Audit readiness in healthcare means operating as if a payer or regulator could review your claims at any time—and being able to prove the services billed and care delivered without last‑minute scrambling. The organizations that avoid denials, takebacks, and compliance findings do not wait for a notice. They build continuous monitoring, routine internal audits, targeted…

DNFB backlog is the volume of encounters that are clinically complete but not yet financially ready to bill. When coding backlogs and DNFB rise, cash gets trapped, audit exposure grows, and leaders lose a clear view of performance. The fastest path to relief is to treat DNFB as a daily management metric, tie trends to…