3Gen Consulting

Healthcare operations are shifting from labor-driven RCM to intelligence-driven ex*****on.

The question is no longer headcount.
It’s friction.

What slows workflows, delays claims, and creates rework - needs to be removed, not resourced.
That’s where performance is now defined.

📞 (888) 886-3436
🌐 https://www.3genconsulting.com/blogs/artificial-intelligence-transforming-rcm-medical-billing-2026/

100%. That's the OIG's finding on sampled acute stroke HCC codes submitted to CMS by Medicare Advantage organizations.

Not 60%. Not 80%. Every single one of the 97 sampled enrollees had acute stroke diagnosis codes that were not supported by the medical records – across multiple MA organizations.

The estimated overpayment: $462 million for 2021 alone.

The OIG recommended CMS implement a procedure to prevent future overpayments of this type. CMS did not confirm it would do so.

For MA plans: the gap is yours to close. Not CMS's.

https://www.3genconsulting.com/blogs/oig-462-million-hcc-risk-adjustment-coding-medicare-advantage-2026/

$462M OIG Audit: HCC Risk Adjustment Coding Alert 2026 The OIG found 100% of sampled acute stroke HCC codes were unsupported across multiple MA plans. Here's what every Medicare Advantage organization needs to know now.

Celebrating courage, strength and the hope that carries survivors forward.

Most denials don’t really surprise anyone in the revenue cycle.
They just arrive later than they should have been prevented.

Yet they’re still treated like back-end problems that need heroic recovery efforts.

The stronger RCM teams take a simpler approach:
→ Fix eligibility before submission
→ Use payer rules before claims are built
→ Validate documentation before billing
→ Eliminate issues at the source

Because preventing 1 denial is usually less effort than explaining 10 of them later.

📞 (888) 886-3436
🌐 www.3genconsulting.com/outsourcing-accounts-receivable/

Some coding errors don’t disappear. They just wait for the next audit.

Same documentation gap.
Same missed specificity.
Same “didn’t we already discuss this?” moment.

Because most teams track errors after they happen.

High-performing coding operations focus on preventing sequels:
→ Root Cause Analysis
→ QA feedback loops
→ DPU/DPO monitoring
→ Process-level correction

98%+ coding accuracy isn’t luck.
It comes from better systems.

📞 (888) 886-3436
🌐 www.3genconsulting.com/medical-coding-audit/