Daniel Ruppar

Defensibility is an Urgent Mandate In our recent article1, we discussed that the Medicare Advantage (MA) financial model has fundamentally shifted. The CFO mandate is no longer revenue maximization; it is defensible accuracy. Regulatory tightening, aggressive DOJ enforcement, and the V28 risk model transition have converged to make audit-readiness a C-level financial priority. The urgency is measurable.

SIIM26’s theme this year was “Building Bridges Across Imaging Informatics”. Here’s what struck me most from sessions, meetings and conversations. Technology components that were once key differentiators — cloud-native architecture, a certain diagnostic AI point solution, or a certain reporting vendor’s tech — are becoming table stakes. So how can this bridge theme apply to what is going on?

Revenue Optimization Without Defensibility Is a Risky Strategy Risk adjustment has been one of the most reliable growth levers in Medicare Advantage (MA) for the better part of a decade.