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

New policy states any separately identifiable E/M service performed on the same day as a minor procedure must be submitted with office notes. … Read More

A cardiac monitoring company and its subsidiary agreed to a settlement with the DOJ following allegations they violated the False Claims Act. … 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

The OIG issued an Advisory Opinion on nurse practitioners providing services that are traditionally performed by primary care physicians. … Read More

A federal court decision highlights the risk providers may face if they do not comply with Medicare Bad Debt regulations. … Read More