Adi Tantravahi

Cofactor partnered with Memorial to bring structure, speed, and visibility to their DRG workflows. What began as a solution for operational backlog quickly became a strategic driver across revenue cycle operations and documentation workflows.

Denials are growing faster than most RCM teams can respond. Payers are scaling AI-powered reviews across evolving policy frameworks. Yet many hospitals are still fighting them manually. This is beyond being inefficient. It's ultimately unsustainable. When payers can deny in seconds but your team needs days to appeal, you're fighting an uphill battle and leaving revenue on the table. We analyzed countless successful complex denial overturns across top payers (Aetna, Anthem, UnitedHealthcare,...

A federal court just blocked CMS's plan to use statistical extrapolation  in Risk Adjustment Data Validation (RADV) audits. MA plans may be celebrating but if you're a provider, here's what you need to understand: The burden of documentation falls on you either way. Whether CMS is using extrapolation or not, your documentation is the foundation of every audit. When payers first review your records, your job is to prove that every diagnosis and procedure was supported by clear, compliant...