Cigna added to the list of codes to be denied if billed without a corresponding CPT or HCPCS code starting May 1, 2023.

Key changes promote transparency in coverage decisions for MA beneficiaries, while ensuring providers can offer the best care for patients.

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

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

CMS issued a proposed rule that could change utilization management and prior authorization criteria for Medicare Advantage plans.

OIG and CMS agree more scrutiny is needed for Medicare bad debt reimbursement and encourage more regular review of bad debts claimed.

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

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

Providers should learn from recent convictions to reduce their risk of committing telehealth fraud and abuse as federal oversight continues.

To combat the growing problem of telehealth fraud, the OIG published a new Special Fraud Alert to help providers avoid telehealth schemes.

The Appropriate Use Criteria Program ensures providers who order outpatient imaging services have medical necessity to do so.

SCOTUS found HHS correctly calculated safety-net payments. Hospitals caring for low-income patients could see payments negatively impacted.