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The Federal Independent Dispute Resolution (IDR) process is entering a new operational phase. For health plans, providers, third-party administrators, billing organizations, and other participants, success will increasingly depend on the quality of the information exchanged before a dispute reaches arbitration. That makes Federal IDR readiness more than a legal or compliance exercise. It is also a claims-processing, data-quality, documentation, and workflow challenge. The Volume of Disputes Makes Process Quality Important Federal IDR is no longer

What is the RCD? The Review Choice Demonstration (RCD) project for Inpatient Rehabilitation Facilities (IRF) seemed like a pipe dream when the Centers for Medicare & Medicaid Services (CMS) started discussing it before the Pandemic. The goal of the RCD is to reduce the burden on providers demonstrating compliance with Medicare IRF rules.  The RCD started out slowly, but is currently in full swing in four states: Alabama (effective August 2023) Pennsylvania (effective June 2024) Texas

Glucagon-Like Peptide-1 (GLP-1) medications have largely been discussed as a pharmaceutical and clinical story. Increasingly, however, they are becoming a healthcare strategy story. A recent Wells Fargo analysis highlighted by Fierce Healthcare suggests that widespread GLP-1 use could disrupt a healthcare system that has historically invested significant resources in treating the downstream consequences of obesity (Fierce Healthcare, 2026). As treatment moves further upstream, healthcare organizations may need to reconsider everything from service-line projections and utilization