News

EDITOR’S NOTE: Lisa Banker, MD contributed to the following report. Medicare Advantage Organizations (MAOs) were warned by federal health officials last week to issue an appealable organization determination when denying or recouping part or all of a payment from a non-contracted provider. The directive came in the form of a Centers…
Congress appears to be closer on a COVID-19 relief package. U.S. Supreme Court Associate Justice Ruth Bader Ginsburg passed away on Friday. Ginsburg was the second woman appointed to the Supreme Court, serving there for 27 years. We mourn her loss, and as a country, we are grateful for her…
Food insecurity is on the rise. Amid the perils of the continuing COVID-19 pandemic are now growing concerns about food shortages around the country. Since COVID began, the U.S. Census has been tracking the impact of the associated economic crisis on the public. The numbers are important for healthcare organizations…
Medicare audits expected soon.Federal healthcare audits have resumed, and they are not limited to durable medical equipment (DME) or any one specific group of providers, any one type of contractor, or any one specific locality in the country. Since the announcement of the ramping up by the Centers for Medicare…
Your data will determine the overall success of your denial prevention and management efforts. No matter how robust the clinical documentation integrity (CDI) program, there are still payer denials. Payer audits become more creative and voluminous each day. Just when we think we have a handle on the top clinical…
Action applies to the Medicare Accelerated and Advanced Payment Loan Program.  In March, the Centers for Medicare & Medicaid Services (CMS) expanded the Accelerated and Advanced Payment Program (AAP) due to the COVID-19 public health emergency (PHE), in an effort to increase cash flow to providers. Under the current terms, repayment for…
The move contrasts with shorter timelines associated with the releases of the IPPS, OPPS rules. In an apparent effort to make providers’ lives a little easier, federal officials earlier this week issued Part I of the 2022 Medicare Advantage (MA) Advance Notice of proposed payment changes. “This announcement of Medicare…
Two payers allegedly inflated their bids. Earlier this month, two Independence Blue Cross (IBC) subsidiaries in Pennsylvania agreed to pay $2.25 million to resolve allegations that they defrauded the Medicare Advantage (MA) program and violated the False Claims Act by improperly inflating their bids. Medicare Advantage, also known as Medicare…