Financial Recovery Group

In value-based healthcare, care gaps represent missed clinical services that can lower quality scores and increase costs. However, an estimated 20% to 40% of these gaps are "paper gaps" — administrative data tracking errors that misrepresent compliant care. Organizations can optimize performance and protect revenue by identifying and resolving process, outcome, and paper gaps through improved analytical reporting.

Read the full article here: https://frgsystems.com/healthcare-finance-news/closing-care-gaps-part-1

For assistance identifying and resolving these care bottlenecks, email FRG at [email protected] or call 888-466-1025.

Closing Care Gaps to Achieve Quality Goals: Part 1 | FRG - Delivering Value Series As costs have risen, plan sponsors have increased their focus on healthcare quality. In this series, learn about care gaps and how to close them.

PMPM (Per Member Per Month) serves as the vital financial compass for healthcare organizations. This metric tracks immediate cost trends, enabling leaders to optimize cost-efficient care and improve patient outcomes under value-based care models. A stable, optimized PMPM directly signals effective preventive care and steady financial operations.

Learn why PMPM remains the most reliable metric to evaluate healthcare efficiency and value: https://frgsystems.com/healthcare-finance-news/what-is-pmpm

PMPM and Healthcare Cost Management | FRG See how PMPM guides healthcare costs and how stronger data and audits help leaders improve accuracy and support better care.

FRG builds healthcare financial intelligence tools for payers and providers, backed by HITRUST r2 certification and compliance with SOC 1 and SOC 2 reporting frameworks. By surfacing gaps between revenue and cost of care, AccuReports replaces fragmented manual analysis with an automated Total Cost of Care environment — helping clients improve margins across Medicare, Medicaid, and value-based arrangements, and focus care where it delivers the strongest outcomes.

Now's the time to talk to FRG: Cyberattacks on healthcare increased by 36% in late 2025, with ransomware accounting for >1/3 of incidents. Read: https://bit.ly/4wU1cIR

When Patient Data Becomes a Single Point of Failure in Healthcare Systems As ransomware attacks escalate and healthcare systems become more interconnected, providers are rethinking cybersecurity as a core component of patient safety, operational resilience...

CMS Administrator Mehmet Oz has named Rebekah Armstrong as the agency's new chief of staff. Armstrong previously led the CMS Office of Legislation, was a vice president at AHIP, and served as HHS’ deputy assistant secretary for legislation.

Read the full leadership update from Becker's Hospital Review: https://www.beckershospitalreview.com/leadership/dr-oz-taps-new-chief-of-staff/

The Department of Health and Human Services Office of the Inspector General estimates CMS may have overpaid Medicare Advantage $462 million in 2021 on stroke diagnoses. An OIG audit examined whether documentation of acute stroke diagnosis codes met federal requirements.

https://www.fiercehealthcare.com/regulatory/oig-feds-may-have-overpaid-ma-plans-millions-due-unsupported-stroke-diagnoses

Struggling to defend risk adjustment submissions? FRG RAMP can manage member records to align with CMS requirements and defend risk adjustment submissions for payers. RAMP continuously analyzes and monitors data and provides the specific diagnosis codes required to complete documentation of HCCs for which members are eligible. For more information, email [email protected] or call 888-466-1025.

OIG: Feds may have overpaid MA plans by millions due to unsupported stroke diagnoses A new federal report suggests that Medicare Advantage plans may have earned millions in overpayments tied to unsupported stroke diagnoses. | A new federal report suggests that Medicare Advantage plans may have earned millions in overpayments tied to unsupported stroke diagnoses.

Healthcare providers lost nearly $10 billion more in 2025 than 2024 due to rising claims denials and uncollected patient bills. A new report Kodiak Solutions highlights that high-dollar inpatient denials and increased administrative burdens for clinical validation significantly affect hospital margins.

Read the full article: https://bit.ly/3QbKJiI

Financial Recovery Group supports healthcare providers with a structured system to present clear proof of services and respond confidently to payer demand letters. FRG’s contestation services help providers review, dispute, and resolve disagreements over payments, performance metrics, or risk-sharing calculations.

To learn more about FRG, your partner for healthcare financial intelligence, visit https://frgsystems.com/.

Rising claims denials dent provider revenue: report Consultancy Kodiak Solutions analyzed revenue cycle data for 2,300 hospitals and 350,000 physicians.

Does increasing Medicare Advantage enrollment hurt hospital margins? Despite widespread industry concerns, a MedPAC analysis shows that rising MA enrollment does not significantly shift profit margins for local hospitals. Instead, it prompts a balanced drop in both revenues and costs.

Get the full breakdown: https://frgsystems.com/healthcare-finance-news/medicare-advantage-hospital-margins

Will Medicare Advantage Growth Hurt Hospital Margins? As Medicare Advantage enrollment grows, many expect hospital margins to decline. A 2026 MedPAC analysis suggests the impact may be less severe than expected.

Balancing financial health and patient outcomes requires a structural shift from volume to value. Sustainable healthcare systems achieve this balance by connecting clinical results directly to financial metrics, a strategy that reduces expensive medical utilization, identifies cost drivers, and protects the core medical mission.

Read the full analysis from Forbes: https://bit.ly/3SbTxWn

AccuReports empowers health plans, MSOs, IPAs, ACOs, and consultants to navigate this transition seamlessly. FRG’s secure, customizable platform uses a unified platform to track quality metrics, providing the clear financial intelligence needed to make confident decisions.

To learn more about FRG, email [email protected] or call 888-466-1025.

How To Balance Financial Strength And Optimal Patient Outcomes Healthcare organizations need both the resources to invest in staff, technology and care delivery and the ability to prove investments lead to positive patient outcomes.

Is your revenue aligned to your members' risk profiles?

FRG’s RAMP helps Medicare Advantage plans and provider groups identify gaps, track chronic condition recapture, and build accurate accruals.

Stop leaving revenue on the table. Read: https://frgsystems.com/healthcare-finance-news/risk-bearing-contracts-with-ramp-by-frg

RAMP by FRG for Risk Adjustment Analytics Learn how RAMP by FRG helps Medicare Advantage plans and risk-bearing organizations identify revenue gaps, improve HCC recapture, and more.

CenterWell’s value-based cardiovascular care model demonstrated rapid success in its first year, achieving a 20% reduction in avoidable heart failure hospitalizations and a 15% decrease in overall admissions. By shifting from volume to outcomes and enhancing collaboration with primary care, the program also lowered the cost of care by approximately 20%.

Read the full success story at

Value-based cardiovascular care focuses on outcomes, not volume At CenterWell, early data shows 20% fewer avoidable heart failure hospitalizations, 15% fewer admissions and 20% lower total cost of care.