Healthcare coding has fundamentally transformed from volume-driven revenue capture to compliance-first, defensible documentation standards.

As the Medicare Advantage market continues to evolve amid regulatory change, margin pressure, and ongoing member movement, it remains a crucial growth and performance priority for many health plans.

For most of Medicare Advantage's history, RADV audits were sporadic. CMS selected a handful of contracts each year. The ...

Inspired by examples in other fields like NASA’s Mission Control, a number of multi-hospital health systems have launched ...

Background Data on the contribution of hepatitis viruses to the burden of hepatocellular carcinoma (HCC) are essential for global hepatitis elimination. Objective To estimate the HCC burden ...

Medicare beneficiaries can receive their benefits either through private plans, known as Medicare Advantage (MA) plans, or traditional Medicare. MA plans now cover more than half of all beneficiaries, ...

Update 3/5/26: We have updated our estimate for Medicare Advantage (MA) overpayments using the most recent February 2026 CBO baseline. We now find MA overpayments will total $1.3 trillion between 2027 ...

Molina Healthcare faces a 2025 margin collapse due to elevated medical costs, but sector-wide premium hikes are expected to restore profitability in 2026. MOH is structurally insulated from Medicare ...

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA ...

Artificial intelligence (AI)-enabled tools such as natural language processing (NLP) have been integrated into a wide range of applications, including risk adjustment coding tools, for greater ...