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Four letters decide whether the diagnoses you submit will survive an audit — and whether you keep the revenue tied to them. M, E, A, T. They look simple. They are also where most risk-adjustment revenue quietly leaks away. 1. What an auditor is actually asking. When CMS or an auditor opens a chart, they […]
The Four Most Expensive Letters in Medicare Advantage: M-E-A-T Read More »
I want to ask the leaders of risk-bearing organizations one question, and I want you to sit with how confidently you can answer it: What is your documentation error rate? Most can’t answer. And in 2026, that gap is the single most expensive thing about your operation. 1. The number CMS already has in mind.
What’s Your Documentation Error Rate? If You Can’t Answer, That’s the Problem. Read More »
When the 2027 Medicare Advantage Rate Announcement came out, almost all the attention went to the headline: rates went up about 2.48%. Plans exhaled. They shouldn’t have. Underneath that number, CMS finalized two changes to how diagnoses can be captured that quietly reshaped the risk-adjustment math — and a lot of organizations haven’t connected the
CMS Just Deleted Two of the Easiest Ways You Were Capturing Diagnoses Read More »
For most of its history, a RADV audit was something a Medicare Advantage plan could treat as background noise. CMS audited fewer than 60 contracts a year. The odds of being selected were low enough that many plans quietly bet they wouldn’t be. That bet no longer exists. 1. What actually changed. CMS has moved
RADV Used to Be a Lottery. In 2026, It’s an Annual Event for Every Plan. Read More »
There is a single number driving almost every change in Medicare Advantage right now, and most leaders haven’t fully absorbed what it means for them. Roughly $17 billion a year. That is CMS’s own estimate of how much it overpays Medicare Advantage plans for diagnoses that aren’t supported in the medical record. In most cases
$17 Billion and Counting: Why CMS Now Treats Your Documentation as a Target Read More »
Artificial intelligence is rapidly entering healthcare. Most discussions focus on clinical use cases:AI scribes.Diagnostic tools.Prior authorization automation.Predictive analytics. But another transformation is quietly emerging — one that could directly affect millions of vulnerable Americans. AI may soon play a growing role in determining who keeps Medicaid coverage. As states prepare to implement Medicaid work requirements
Healthcare AI Is Quietly Moving Into Medicaid Eligibility Decisions Read More »