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The fate of these hospitals looks grim. Rural hospitals have long been considered “on the edge.” They typically serve populations that are old, less affluent,
AMA scores a hit with new guidelines; misses simplification of one subset of hospital E&M codes. It was a happy day in 2020 the American
Double-dipping has been seen among some Managed Care Organizations. How many readers have undergone more than one audit? What about more than one audit for
Although the Biden Administration claims this is the final regulation, there is evidence more is yet to come. The Biden administration released the final No
Overcoming the Medicare Advantage bullies. It is a well-known fact that denials are increasing exponentially. The commercial payers, especially the Medicare Advantage Organizations (MAO), have
CMS has specific guidelines when defining “incident to” and shared visits. Recently, I was working with a client to help them understand “incident to” billing.
New changes impact the ADR limits for RACs. The Centers for Medicare & Medicaid Services (CMS) has modified the additional documentation request (“ADR”) limits for
The proposed rule is designed to reduce red tape associated with enrollment in Medicaid and related programs. In a move that some might surmise as
The FAQ released recently yields information on the Independent Dispute Resolution. The FAQs related to the No Surprises Act final rule was released last week.
New guidance follows a report to CMS by the OIG on Medicare Advantage Organization’s inpatient clinical criteria in denying claims. EDITOR’S NOTE: This story is
Understanding Medicaid’s Money Follows the Person (MFP) demonstration. This past week, the Centers for Medicare & Medicaid Services (CMS) announced that it would be expanding
Complaints are abundant from beneficiaries. Last week saw the release of another audit of a Medicare Advantage (MA) plan from the U.S. Department of Health
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