Insurance agent Jason Fine says he is helping dozens of clients undo Affordable Care Act health plan switches that were made without their consent. The Government Accountability Office reports that fraud involving unauthorized plan changes and enrollments remains an issue for the Affordable Care Act, despite new CMS rules. The CMS fielded more than 275,000 complaints about unauthorized ACA enrollments and plan switches in 2024, and the GAO estimates that about 1.5% of ACA enrollments are fraudulent. Congress is divided about how to address the matter.

Clinical documentation integrity remains a vital component of the hospital revenue cycle, but the field is at a crossroads, writes certified documentation integrity practitioner Cheryl Ericson. Early CDI efforts were focused on improving case mix index and capturing complications for incremental revenue, but today's environment of high costs and denied claims demands a shift toward documentation integrity rather than mere improvement. With most hospitals now accurately reflecting patient acuity, CDI efforts can shift to support quality metrics, risk adjustment and denials management in collaboration with other departments to ensure accurate, compliant, defensible documentation, Ericson writes.

Some federally qualified health centers have sued low-income patients, garnished wages and sent accounts to debt collectors over unpaid medical bills. Many of those sued qualify for discounted care, and although some of the initial bills are small, costs have ballooned as interest and legal fees are added. Community health centers say they take legal action as a last resort due to financial instability, and federal law requires them to make "every reasonable effort" to collect payment. However, experts say aggressive collection practices contradict community health centers' mission to provide health care regardless of patients' ability to pay.

EHR alerts for malignancy, heart failure, opioid prescription or dementia can be set up to trigger initiation of advance care planning, according to a study in BMJ Open. Clinicians "can use the triggers identified in the EHR in an automated computer search to prioritise patients for [advance care planning]," researchers wrote.

Join us October 4-6, 2026, in San Antonio, Texas, as a presenter and connect with health information professionals nationwide. Submit your presentation abstract by January 26 for consideration. Whether you're a seasoned speaker or first-time presenter, AHIMA26 is your chance to get into the spotlight and share your HI expertise. Visit the Submission Site for more details.

Piedmont Health is leveraging artificial intelligence to enhance efficiency and the patient experience in the revenue cycle, says Allyson Keller, vice president of the Patient Connection Center. Projects include optimizing orders through interoperability, scaling automated voice assistants and improving speech recognition to better understand patient behavior. Keller highlights the potential of AI to automate clinical data extraction and ensure adherence to payer policies, which could reduce claim denials.