by Kristin Wallick, MD, FCCP, Joseph A. Cristiano, MD, FACP, CCDS, CHCQM-PHYADV, and Eleanor K. Fertig, MD, ACPA-C, CCDS, CHCQM
The American College of Physician Advisors Clinical Documentation Committee strongly supports the importance of up-to-date, complete, and accurate...Read More »
Peers and colleagues who know me well are keenly aware that the word “denial” makes me irate. The main reason for my denial disdain is due to the fact that payers, who have had no patient contact whatsoever, believe they possess the...Read More »
A Connecticut psychologist, Michael Lonski, Ph.D., has been sentenced to 27 months in federal prison for committing a healthcare fraud scheme, according to JustCoding. Lonski was...Read More »
In fiscal year (FY) 2024, United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) audits and investigations conducted are expected to recover $3.44 billion, as reported in the fall 2023...Read More »
UnitedHealthcare (UHC) is facing a class action lawsuit, alleging the company illegally used artificial intelligence (AI) to “systematically deny” skilled nursing facility (SNF) claims, according to Medscape.
In 2022, insufficient documentation caused approximately 91% of improper payments by CMS, according to a report released by the United States Department of Health & Human...Read More »
The Office of Inspector General (OIG) recently completed an audit of CarePlus Health Plans, Inc., finding that 466 out of the 1,656 hierarchical condition category (HCC) codes reviewed could not be validated, according to a federal ...Read More »
Nearly 50% of providers have seen an overall increase in their denials rate compared to the previous year, according to a recent survey commissioned by AKASA. Another 27% said they saw no change, and 26% reported a decrease from 2022 to...Read More »
