CMS Tightens Prior Authorization Time Frame in Final Rule
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
January 30, 2024
Congress Investigates OIG Report That Medicaid MCOs Deny Prior Authorizations at Higher Rates
A report from the OIG found some MCOs have unusually high rates of prior authorization denials, with limited or no state oversight. … Read More
October 3, 2023
2024 Medicare Advantage Program Changes: What You Need to Know
This new rule introduces several key changes that will promote transparency and consistency in healthcare coverage decisions. … Read More
July 18, 2023
New Revenue Codes to Be Denied by Cigna Without Corresponding CPT or HCPCS Codes
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
May 3, 2023
CMS Final Rule: Changes to the Medicare Advantage Program
Key changes promote transparency in coverage decisions for MA beneficiaries, while ensuring providers can offer the best care for patients. … Read More
May 3, 2023
CMS Proposes Updates to Medicare Advantage Utilization Management Policies + Overpayment Standards: Comments Due Feb. 13
CMS issued a proposed rule that could change utilization management and prior authorization criteria for Medicare Advantage plans. … Read More
January 30, 2023
Be Prepared for Increased Medicare Bad Debt Compliance Scrutiny
OIG and CMS agree more scrutiny is needed for Medicare bad debt reimbursement and encourage more regular review of bad debts claimed. … Read More
January 28, 2023
OIG Advisory Opinion: Providing Nurse Practitioner Services for Referring Physicians Poses Minimal Anti-Kickback Risk
The OIG issued an Advisory Opinion on nurse practitioners providing services that are traditionally performed by primary care physicians. … Read More
January 25, 2023
How to Ensure Compliance With Federal Regulations for the Reimbursement of Medicare Bad Debt
A federal court decision highlights the risk providers may face if they do not comply with Medicare Bad Debt regulations. … Read More
October 19, 2022
OIG Special Fraud Alert – Telehealth
To combat the growing problem of telehealth fraud, the OIG published a new Special Fraud Alert to help providers avoid telehealth schemes. … Read More
August 23, 2022