News

The recent decision by Cigna to administratively deny claims lacking corresponding CPT/HCPCS codes for revenue codes 270-279 is not expected to have a significant impact on revenue. However, this change does raise some administrative concerns, particularly for providers operating under percent-of-charge payment agreements with Cigna.

In summary, this new rule introduces several key changes that will promote transparency and consistency in healthcare coverage decisions for MA beneficiaries, while ensuring healthcare providers are able to provide the best possible care to their patients.

Submitting office notes with all claims using modifier 25 to indicate a separately identifiable E/M service and minor procedure means providers and revenue cycle professionals will spend more time and resources billing these claims.

CMS is accepting comments until March 13 on its proposed rule to improve interoperability between payers and providers and eliminate barriers in the prior authorization process that put undue burden on providers and potentially put patients at risk.

A cardiac monitoring company and its subsidiary agreed to a $44.9 million settlement with the Department of Justice (DOJ) following allegations they violated the False Claims Act (FCA) by billing federal programs for heart monitoring services that were knowingly performed outside the US. by unqualified technicians.

The Biden Administration announced Jan. 30 that the COVID-19 public health emergency (PHE) declaration will end on May 11 with the goal of preventing an abrupt end and allowing more than 90 days for healthcare providers to adjust to the operational and financial implications.

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.

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.

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.

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.