Major Insurers Running Billions of Dollars Behind on Payments to Hospitals and Doctors

Jay Hancock, Senior Correspondent, Kaiser Health News October 6, 2021 Anthem Blue Cross, the country’s second-biggest health insurance company, is […]

Overcoming Clinical Validation Denials Based on the CTCAE

By Richelle Marting, JD, MHSA, RHIA, CPC, CEMC, CPMA, CPC-I | August 23, 2021 | Audits, Appeal Writing, Appeals, Clinical […]

Medicare Advantage in 2021: Enrollment Update and Key Trends from Kaiser Family Foundation

By Denise Wilson | June 29, 2021 | CMS, Medicare Advantage Kaiser Family Foundation (KFF) issued a report on June […]

UHC to Audit Sepsis Claims on a Pre-Pay Basis

By Denise Wilson | May 11, 2021 | Audits, Denials, Evidence-Based Guidelines, Medicare Advantage, Sepsis United Healthcare (UHC) has announced […]

Quality Assurance of COVID-19 Reimbursements and Reporting

This bill establishes documentation requirements for testing, treatment, and reporting related to COVID-19; and makes it unlawful to knowingly report […]

CMS to Pilot ADR Request for Radiology Services

On October 30, 2020 CMS announced a pilot process to enable Medicare Administrative Contractors (MACs) to receive pertinent documentation from […]

Appeal Rights for CMS’s Prior Authorization Process for Certain Outpatient Department Services

Now that the prior authorization process that CMS put into place for certain outpatient department services is in full swing, […]

Medical Record Electronic Submission to BFCC-QIO Kepro and Livanta

Starting October 1, 2020, the Centers for Medicare & Medicaid Services (CMS) regulations require providers (including short- and long-term acute […]

New COVID-19 Policies for Inpatient Prospective Payment System (IPPS) Hospitals Limits the 20 Percent Increase in Weighting Factor for COVID-19 DRGs

On August 17, 2020, CMS released a revised MLN Matters SE20015 to announce a change in the application of the […]

CMS to Resume Post Payment Audits

CMS has announced that to protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service […]