The Wasteful and Inappropriate Service Reduction (WISeR) Model introduces prior auths for select services at risk of fraud, waste and abuse. … Read More
Shifts in federal policy may lead to more activity at the state level. Here some state bills seeking to regulate the use of AI in healthcare. … Read More
A new corporate whistleblower program incentivizes reporting of healthcare fraud involving private insurance plans. … Read More
Health plans will be required to meet a prior authorization time frame as short as 72 hours, along with providing reasoning for any denials. … Read More
A report from the OIG found some MCOs have unusually high rates of prior authorization denials, with limited or no state oversight. … Read More
This new rule introduces several key changes that will promote transparency and consistency in healthcare coverage decisions. … Read More
Cigna added to the list of codes to be denied if billed without a corresponding CPT or HCPCS code starting May 1, 2023. … Read More
Key changes promote transparency in coverage decisions for MA beneficiaries, while ensuring providers can offer the best care for patients. … Read More
CMS issued a proposed rule that could change utilization management and prior authorization criteria for Medicare Advantage plans. … Read More
OIG and CMS agree more scrutiny is needed for Medicare bad debt reimbursement and encourage more regular review of bad debts claimed. … Read More