The Wasteful and Inappropriate Service Reduction initiative from CMS is set to take effect Jan. 1, 2026, introducing new prior authorization requirements for select services. Here are seven things to ...

If you are a healthcare provider enrolled with Medicare and Medicaid, it is imperative that you know the governmental agencies’ expectations for compliant billing and understand that the agencies ...

Differential coding by Medicare Advantage plans appeared to have pushed their risk scores higher than traditional Medicare's scores. Those greater risk scores led to $33 billion in extra revenue for ...

New bipartisan legislation hopes to cut overpayments to Medicare Advantage (MA) plans as federal government efforts have run into a massive opposition campaign. Sens. Bill Cassidy, R-Louisiana, and ...

While enrollment in Medicare Advantage has increased over time and allows payers to offer extra benefits to beneficiaries, the program may be contributing to barriers and disruptions to care according ...

Paul D. Jacobs ([email protected]), Agency for Healthcare Research and Quality, Rockville, Maryland. There is widespread agreement that taxpayers pay more when Medicare beneficiaries are enrolled in ...

Anesthesia billing complex get right by mastering unique codes, time-based factors, and modifiers to reduce denials and maximize revenue.