Ensemble Health Partners (Ensemble), an industry-leading revenue cycle management company, announced it has been recognized as a top workplace in the country by two national organizations.
Read More
CMS recently issued a proposed rule that, among several other revisions, could change utilization management and prior authorization criteria for Medicare Advantage (MA) plans as well as amend the definition of an identified overpayment – both of which could impact providers.
Read More
OIG recommended to the Centers for Medicare & Medicaid Services (CMS) that it consider issuing instructions or guidance to the Medicare Administrative Contractors (MACs) that would require or encourage the MACs to more regularly review Medicare bad debts claimed on cost reports.
Read More
Insurance companies are increasingly denying payment of medical claims received from healthcare providers. A recent report found that 11% of claims were denied in 2022, which equates to 110,000 denials for the average-size health system. The rate of prior-authorization denials doubled in the past year alone and request-for-information denials, which essentially serve as pre-pay audits for payors, are increasing rapidly.
Read More
The Office of Inspector General (OIG) recently issued an advisory opinion in response to a hospital’s request to determine if their arrangement with attending physicians violated the Federal anti-kickback statute. The arrangement in question allows the hospital’s employed nurse practitioners to perform services traditionally performed by a patient’s attending physician.
Read More