Over the last few years, there has been an uptick in Medicare billing privileges deactivations for failure to timely and fully update or revalidate Medicare enrollment information and respond to ...

A new study published in JAMA found that a new Medicare add-on billing code boosted pay significantly for specialists. The study analyzed Medicare claims data from 2024, the first year that the G22111 ...

Pharmacy claim reversals can be costly. Not only can they have an immediate impact on pharmacies’ cash flow; but, in many cases, they can lead to additional consequences as well. Pharmacies accused of ...

CMS has published online most of the edits utilized in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments for Medicare Part B services. These edits, applied during ...

Two recent Department of Justice settlements with health care providers shine a new spotlight on a long-standing risk for health care fraud and abuse. Two recent Department of Justice settlements with ...

Vice President JD Vance and CMS Administrator Mehmet Oz, MD, announced a series of actions affecting Medicare and Medicaid, including a $259.5 million deferral of federal Medicaid funding in Minnesota ...

Rampant Medicare fraud schemes in Los Angeles allegedly bilk taxpayers for billions through fake home health agencies and ghost patients across the city.

For many years, primary care providers had no direct or explicit mechanism to be reimbursed for services specifically provided to Medicare and Medicaid beneficiaries under the collaborative care model ...

Medicaid managed care policy shifts scheduled for 2026 are poised to affect how home care agencies process and submit claims significantly. New compliance benchmarks, reporting expectations, and data ...