Of the metropolitan statistical areas in the United States, 79% have Medical Advantage (MA) markets that were highly concentrated in 2021, according to a...Read More »
The timeline for publication of the Medicare Advantage Risk Adjustment Data Validation (RADV) regulations has been extended further until February 1, 2023, according to a...Read More »
2023 annual payment updates for physicians, the Medicare shared savings program, and outpatient and home health services have all been published by CMS on October 31, 2022.
Some commercial health insurers apply policies that delay patient care, burden providers, and increase costs, according to a new report and infographic...Read More »
A recent audit by the Office of Inspector General (OIG) found that changes to CMS' system has significantly reduced Medicare overpayments to acute care hospitals for outpatient services. The OIG showed $39.3 million in overpayments had been made, particularly for services provided to...Read More »
The Office of Inspector General (OIG) is calling for Humana Inc. to refund $34.4 million in alleged overpayments made to the payer's HumanaChoice Medicare Advantage plan in 2016 and 2017,...Read More »
Q: Does your facility currently abide by any policies when it comes to coding ‘obesity’ and/or ‘morbid obesity’ in terms of requirements for the provider to document how the diagnosis has met the Uniform Hospital Discharge Data Set (UHDDS) definition of ‘monitoring, evaluating,...Read More »
