The Centers for Medicare & Medicaid Services (CMS) desires to use the best data available when rate setting for the upcoming fiscal year. Because COVID-19 unsettled the playing field within the healthcare arena, CMS made the decision to use data from 2019 instead of 2020 due to the COVID-19 public health emergency...

One of the provisions in the changes to the federal physician self-referral prohibition, better known as the Stark Law, announced in December 2020 imposes new limits on physician group practices. In particular, the Centers for Medicare & Medicaid Services (CMS) is...

In a complaint filed last week, a New York data-mining company, DxID, was accused of allegedly helping a Medicare Advantage (MA) program game federal billing regulations in a way that enabled the plan to overcharge for patient treatment.

Both providers and payers have major concerns with how regulations to ban surprise medical bills will be implemented next year, with providers concerned about added burden and insurers clamoring for more time.

Innovative work to meet the urgent public health need for streamlined reporting and tracking of COVID-19 vaccinations is presented in today’s release of the 2022 Current Procedural Terminology (CPT^®) code set published by the American Medical Association (AMA). The annual update to the CPT code set incorporates...

Two years ago, the federal government created a plan to audit Medicare Advantage (MA) insurers more aggressively: the MA Risk Adjustment Data Validation (RADV) program. But that plan has been sitting in regulatory limbo for two years – and not just because of COVID. The plan will claw back billions of taxpayer...