What changed, who it affects, and what to do.
Rules, reports and developments in US health operations, read against the primary sources.
What changed, who it affects and what to do about it. Dated, and revisited when rules change.
AI Coding Tools and Rising Case Complexity: What the BCBSA Analysis Shows, and What It Doesn’t
Insurers say hospital AI coding added about $942 million in costs. Hospitals say the claims data cannot prove it. Both can be partly right, and both point to the same homework for any organization that uses AI in coding.
Read moreCMS-0057-F: What the Prior Authorization Rule Means for Providers Before January 2027
The rule puts its obligations on payers — faster decisions, specific denial reasons, public metrics and FHIR-based APIs. But the benefits reach only the providers who are ready to use them. Here is what is already in force, what arrives on January 1, 2027, and what to do now.
Read moreCY2027 Medicare Physician Fee Schedule: What RCM Teams Need to Model Before January 1
CMS’s proposed CY2027 rule cuts the conversion factor, rewrites same-day E/M billing, and locks remote monitoring to in-house staff — all ahead of a final rule due in November. Here’s what to model now, and what to hold off on until the ink is dry.
Read moreRegulatory Watch
Plain-English analysis of CMS and compliance changes that hit revenue cycle teams — when it matters, not weekly noise.
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