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
Regulatory Updates
Ideas, insights + industry updates
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
Cigna Reimbursement Policy Change: Office Notes Required to Bill E/M Service Separate from Same-Day Minor Procedure
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
April 10, 2023
Diagnostic Monitoring Services Under Increased Federal Scrutiny Following $45M Settlement
A cardiac monitoring company and its subsidiary agreed to a settlement with the DOJ following allegations they violated the False Claims Act. … Read More
February 24, 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
How to Mitigate Risks of Telehealth Fraud + Abuse
Providers should learn from recent convictions to reduce their risk of committing telehealth fraud and abuse as federal oversight continues. … Read More
September 16, 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