Proper provider payer enrollment and credentialing are critical to minimizing denials, reducing compliance risks, and ensuring timely reimbursement. Learn why clearly defined ownership and ongoing management of this process are essential to revenue cycle health in the full article linked below.
Accurate E/M coding is vital to both patient care and reimbursement, yet many future physicians receive little formal training in this area. Explore how early education and the right resources can equip medical students and residents with the skills needed for compliant documentation, optimized billing, and a successful transition into practice.
Is your facility simply collecting revenue, or actively cultivating it through collaboration? Discover how bridging the gap between finance and operations can uncover hidden reimbursement opportunities and drive long-term financial success.
Lake Region Healthcare Corporation v. Becerra
In late 2024, Lake Region Healthcare Corporation v. Becerra was decided in favor of the Provider at the Washington, D.C. Circuit Court. This is a major win for Sole Community and Medicare Dependent Hospitals nationwide, who have continued to fight to receive the proper payment under the Volume Decrease Adjustment (VDA) program. This ruling will benefit hospitals that have appealed to have positive PRRB decisions enforced and those that are still in process at the PRRB.” https://caselaw.findlaw.com/court/us-dc-circuit/116542163.html
CMS Cracks Down on Medicare Advantage Overpayments: Is your practice ready for a surge in RADV audits and appeals?
The Centers for Medicare & Medicaid Services (CMS) has unveiled a sweeping new strategy to increase oversight of Medicare Advantage (MA) plans by significantly expanding the Risk Adjustment Data Validation (RADV) audit program.
Historically, CMS audited a small sample of plans annually, but moving forward, every Medicare Advantage plan will be audited each year. Combined with a massive hiring effort and backlogged audits from payment years 2018 through 2024 being pushed to completion by early 2026, this marks a pivotal moment for healthcare providers, especially physician practices. Practices should brace for a sharp uptick in RADV-related activity—particularly appeals—as CMS looks to recoup overpayments tied to unsupported diagnosis coding.
What This Means for Providers
Actionable Takeaways
Did you know RubinBrown expanded its healthcare services through the acquisition of The Rybar Group nearly a year ago? This combination brought over 300 years of collective experience in healthcare finance, reimbursement, and revenue cycle management to our team. With this added expertise, we’re better positioned than ever to help providers optimize reimbursement, improve financial performance, and navigate today’s complex healthcare landscape. Our team is committed to supporting your continued success with strategic, hands-on solutions tailored to your needs.
This interactive session is designed specifically for physician leaders, program directors, administrative leaders, and medical coders. This practical and insightful webinar will discuss the tools and knowledge needed to strengthen provider documentation, boost compliance, and improve reimbursement accuracy.
Discover how your organization can maximize the financial and operational benefits of the Rural Health Clinic (RHC) designation. This session will explore key reimbursement strategies, real-world examples, and practical steps to help both new and existing RHCs improve sustainability and expand access to care.
RubinBrown kicked-off its Rural Healthcare webinar series by exploring key regulations, common pitfalls, and strategies to help rural healthcare providers avoid costly errors and unlock reimbursement opportunities.
From Compliance to Strategy: How Cost Reports Can Guide Rural Hospital SuccessThis interactive session demonstrated how a hospital’s cost report can serve as more than just a compliance document, but rather as a strategic tool for identifying hidden revenue opportunities and shaping financial strategies.
21st Annual Healthcare Private Equity and Finance ConferenceHealthcare private equity leaders expressed measured optimism across diverse sectors despite ongoing economic and regulatory headwinds, highlighting investment growth in healthtech, pharma services, and Medicaid-heavy markets. Across all discussions, strategic alignment with third parties and a patient-centered, tech-enabled approach emerged as key drivers of long-term success in an evolving healthcare landscape.
If you were unable to attend any of our webinars but would like additional information, please contact Claudine Hildreth at claudine.hildreth@rubinbrown.com / 810.853.6182