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4 Min Read

Judgment on life expectancy at issue in Medicare fraud case

The case concerns qualifying a patient’s care under the Medicare hospice benefit. At issue is a physicians’ ability to exercise their clinical judgment in certifying a patient’s life expectancy is less than six months.

Medicare & Medicaid
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3 Min Read

Reports show 2017 Medicare payment adjustments

Two new reports with information on 2015 cost and quality data indicate which physicians or practices will see related Medicare payment adjustments in 2017.

Medicare & Medicaid
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2 Min Read

Supreme Court rules against delayed lawsuits, damages

Physicians who provide services under Medicare and other federal health care programs won’t face the possibility of civil lawsuits being brought against them for an unlimited period, thanks to a recent decision by the Supreme Court of the United States.

Medicare & Medicaid
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2 Min Read

AMA still concerned about value-based modifier program

The AMA is concerned by CMS' announcement that a third of large physician groups will face a penalty under the Value-based Modifier program (VBM) in 2015.

Press Releases
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3 Min Read

Payment recovery audit program needs overhaul: Doctors to CMS

A “bounty-hunter” Medicare program that takes back payments from physicians must be overhauled, physicians told the Centers for Medicare & Medicaid Services (CMS) in a letter, pointing to a two-year backlog of appeals and prohibitive expenses that result from excessive audits. ...

Medicare & Medicaid
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3 Min Read

Don't proceed with eRx and PQRS audits, AMA tells CMS

Following a Centers for Medicare & Medicaid Services announcement of a proposal to conduct audits of physicians and other eligible professionals who received incentive payments under the Medicare Physician Quality Reporting System and ePrescribing programs, the AMA called on the agency to abandon its plans because of numerous implementation problems.

Medicare & Medicaid
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3 Min Read

No more secrets: Insurer claim edits come into the light

Expensive claim denials and unexpected payment adjustments that stem from the hundreds of proprietary claim edits individual health insurers create behind closed doors could become a thing of the past in a few short years, thanks to an initiative underway in Colorado.

Claims Processing
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2 Min Read

CMS suspends RAC audits, sets up physician safeguards

Physicians and hospitals will get a short reprieve from Medicare's recovery audit contractors, CMS recently announced.

Medicare & Medicaid
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2 Min Read

Overriding doctor's orders-Case takes up hospital observation

A federal court case is shining light on the growing problem of inappropriately classifying hospital patients as “observation status” in an effort to cut down Medicare costs.

Medicare & Medicaid