News

Individual policyholders in Georgia launch a class-action lawsuit against Anthem for deceptive sales. Early last week, Frances Kirby and John David Marks, two individual policyholders from Cook County, Georgia, filed a class-action lawsuit in federal court in Atlanta against Anthem and Blue Cross Blue Shield of Georgia for allegedly misleading…
CMS also has updated its therapy manuals, making elimination of FLR official. Many therapy providers, at hospital outpatient departments and private-practice clinics alike, were reluctant to stop submitting functional limitation reporting codes and impairment modifiers until they could see the guidance clearly written in black and white in the associated…
Weighing the difficult decisions being made in the business of healthcare. Medicine has commonly been considered one of the most altruistic professions.  From long years spent in training to long hours spent caring for others and the perpetual drive to heal those who are hurt and comfort those who are…
Patients “managed” out of benefits on Medicare Advantage programs. Administrative overhead for Medicare fee-for-service operations typically runs at approximately 2-3 percent. Overhead for commercial insurance plans has been reported to be 18-20 percent. So, what services are being denied by Medicare Advantage (MA) plans to account for this cost difference?…
CMS squeaks by with B-plus in OIG audit. If the Centers for Medicare & Medicaid Services (CMS) received a grade for its audit performance during the 2015 and 2016 fiscal years, it would have been about a B-plus, maybe waived up to an A-minus, according to an announcement made recently…
MAC to audit physicians who prescribe opioids. It is well-known to the medical community and to the general public that the opioid epidemic has taken too many lives. The causes are myriad (I outlined these in a KevinMD.com article in 2016, the second most-read article of the year on that…
“Non-essential” services are healthcare data services upon which providers come to rely. EDITOR’S NOTE: A second government shutdown remains a possibility if a group of bipartisan lawmakers fails to reach an agreement by Feb. 15 on a border security funding package that would avoid a veto from President Trump. Here…
Controversy Swirls: Payers vs Providers EDITOR’S NOTE: Attorney David Glaser reported this story live on Monitor Monday today. That statement may appear to be somewhat controversial, but it shouldn’t be. First, plans are required to provide the patient with benefits that are at least as generous as those required under…