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The Downgrade Era: How Payers Are Changing the Game with (My) Richelle Marting

Listen to the podcast here. Payers are constantly shifting tactics to find new and creative ways to do their favorite thing: Not pay claims. And if…

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Grassley Report of UnitedHealth Group takes aim at these 20 diagnoses: Here’s why

By Brian Murphy   The Grassley Report examining the risk adjustment practices of UnitedHealth Group (UHG) is much more than just a one-time media splash….

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Medicare Advantage plans: Should healthcare organizations care about payer audits, fines? Hint: Yes

You are a CDI Director at a large integrated healthcare system, with oversight of staff working in acute care hospitals and clinics. You have patients…

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Financial success of Comprehensive Care for Joint Replacement (CJR) model paved way for TEAM

By Brian Murphy   The Comprehensive Care for Joint Replacement (CJR) model is over, and it generated savings to Medicare. How much? We await the…

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New Norwood special report examines latest trends in payer denials

Download the report here. Denials are being turned up, not down. But they’re happening in less noticeable and more insidious ways, often under a different…

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