News

Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care

WHY WE DID THIS STUDY A central concern about the capitated payment model used in Medicare Advantage is the potential […]

A Recent Appeal Decision Out of The United States Court of Appeals for The Fourth Circuit Sheds Light on Several Missteps Made by an Employee Retirement Income Security Act (ERISA) Plan

A recent appeal decision out of the United States Court of Appeals for the Fourth Circuit sheds light on several […]

Report on Medicare Compliance Volume 31, Number 13. April 11, 2022 Physicians Don’t Have to Specify Scientific Evidence in Chart, Expert Says

Report on Medicare Compliance Volume 31, Number 13. April 11, 2022 Physicians Don’t Have to Specify Scientific Evidence in Chart, […]

Prior Authorization Reform Has Been Signed into Law

APRIL 7, 2022 More than three years ago, physicians, patients and other health professionals and advocacy associations, led by the [...]

HHS policy update: Recent developments include an extension of the public health emergency and notable progress in reducing the Medicare appeals backlog

Nick Hut | April18th, 2022 Progress being made in reducing a vast Medicare appeals backlog The American Hospital Association (AHA) […]

Court: Patients Must Be Able to Appeal Status Change from Inpatient to Observation

Report on Medicare Compliance Volume 31, Number 4. January 31, 2022 By Nina Youngstrom In a development that will shake up […]

Note from the ACDIS Director: OIG announces audits of Medicaid inpatient hospital claims for severe malnutrition; ACDIS wants to hear about your experiences

Brian Murphy, Director for ACDIS, December 16th, 2021 – CDI Strategies – Volume 15, Issue 55 For the last few […]

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 […]