Medicare news

Discover what Cigna's new downcoding policy means for coding accuracy, audit readiness, and payer relations. 

Hear expert insights on how HIM professionals should prepare to navigate heightened risk adjustment data validation (RADV) audit scrutiny.

As Medicare payment ramps back up after the recent government shutdown, revenue cycle professionals must pay particular attention to certain items.

CMS is preparing to conduct the Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey (ODACS) to collect specific acquisition costs for outpatient drugs and biologicals purchased by hospitals paid under the OPPS.

Review findings from the American Hospital Association that highlight recent improvements in patient safety measures and outcomes.

Learn about potential changes to the Medicare Advantage (MA) and Part D prescription drug programs for contract year (CY) 2027.

Review price transparency updates and other changes in the 2026 Outpatient Prospective Payment System (OPPS) final rule. 

Analyze recent social determinants of health (SDOH) updates and strategies for continued capture.

Examine how the potential expansion of risk adjustment data validation (RADV) auditing efforts could impact HIM professionals.

CMS' current bundling methodology for opioid use disorder (OUD) treatment payments does not accurately reflect care provided to Medicare enrollees, according to the Office of Inspector General (OIG).