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...

CMS has requested that Medicare Advantage organizations relax or waive prior authorizations due to the impact of the coronavirus Delta variant.

Research shows that about 14 percent of adults developed at least one new clinical sequela requiring medical care after recovery from COVID-19, though many specifics have yet to be clarified.

Your practice is considering making a move—or has moved—to a collaborative care model so patients have greater access to mental health care in the primary care setting. It’s a model that requires collaboration and coordination that doesn’t always fit into previous billing codes.

Despite skepticism, artificial intelligence (AI) can be a boon for physicians…but some improvements are needed first. Notably, AI algorithms need to be validated, and bias toward particular groups of patients must be removed from them if they are to achieve their full...

Last week, the Centers for Medicare & Medicaid Services (CMS) started the release of the 2022 final rules, for inpatient psychiatry, inpatient rehabilitation facilities (IRFs), hospice, and skilled nursing facilities (SNFs). And I can sum them up by saying for the majority of our audience, these four rules could not be more boring.