CMS Is Handing Plans a New Way to Check Its Math on Kidney Patients
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Two new CMS rules decide which diagnoses still count in 2027 — and both land in July, not January.
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New EDPS edits reshape supplemental benefit reviews, ICD validation, clinical trial billing, and late encounter adjustments.
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CMS tightens RAF eligibility rules for unlinked chart reviews and audio-only services.
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Stricter validations and new rules reshape claim approvals
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Acceptance is not eligibility: CMS filters encounter diagnoses after submission, and unlinked records are the most vulnerable.
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Q1 2025 Encounter Data Report Cards for Medicare Advantage Plans
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How MAOs Can Optimize Encounter Data Reporting
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Where accuracy meets accountability in MA reporting.
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Decoding CMS’s December software rollout.
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With AI-Enabled Risk Adjustment Solutions
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