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Search results for "medicare and medicaid"
Medicare and Medicaid Risk Adjustment: A Modern Guide for Medical Coders
Risk adjustment is more than numbers—it’s about representing every patient’s story accurately. Discover how coders can bridge data gaps, improve care quality, and strengthen organizational performance.
Beyond the Headlines: The Truth About Medicare Legislative Payments During the…
Despite viral claims that physicians won’t get paid during the shutdown, most Medicare payments continue—except where Congress has let key funding provisions lapse.
Accelerating RADV Audits: Strategies for Medicare Advantage Plans to Manage…
As CMS expedites Risk Adjustment Data Validation audits and reviews multiple plan years retroactively, Medicare Advantage organizations need to shift from reactive cleanup to proactive integrity in coding, documentation, and data governance.
Navigating Medicare and Medicaid Audits: Why Providers Feel Stuck in the…
A deep dive into the real-world challenges of Medicare and Medicaid audits, exploring complex appeal structures and the financial pressures driving providers away from treating publicly insured patients. Learn the differences, risks, and necessary…
2026 Medicare Physician Fee Schedule: Key Policy Shifts in Outpatient Care
Explore the 2026 Medicare Physician Fee Schedule Final Rule's impact on reimbursement and accountability, including changes in telehealth, practice expenses, drug pricing, and value-based care. Understand how to maintain financial resilience and…
2026 Medicare Premiums and Deductibles: Key Highlights and Expert Insights
Explore what CMS’s newly released Part A, Part B, and Part D updates mean for patient affordability, utilization trends, and practice revenue. Includes expert insights on how proactive RCM strategy protects your bottom line.
Medicare Policy Changes for Healthcare Providers
Breakdown of policy updates including site-of-care shifts and telehealth refinements to help healthcare providers stay compliant and protect revenue.
CMS Expands Medicare DMEPOS Oversight
CMS has expanded its Medicare DMEPOS Master List, introducing new prior authorization and documentation requirements for healthcare providers and suppliers.
Strategic Guide for Hospitals Navigating Medicare Payment and Compliance Changes
The IPPS Final Rule introduces updates to hospital reimbursement, MS-DRGs, quality reporting, and value-based care models to protect revenue and compliance.
Occupational Therapy Billing in 2026: Navigating Change, Maximizing Revenue…
Occupational therapy billing is evolving rapidly in 2026. This article covers the latest CPT updates, Medicare changes, compliance risks, and proven strategies to reduce denials, improve accuracy, and protect your practice’s revenue.
Revenue Cycle Management Services for Healthcare Providers
The healthcare policy landscape is transforming, impacting reimbursement models, telehealth expansion, and patient access rights. Providers must stay informed for financial stability and regulatory compliance.
HCPCS Level II Update for Medical Billing
Details on drug coding changes, telehealth services, and documentation requirements to assist medical billing and reimbursement workflows.
Rethinking Risk Coding in 2025: Why Commercial Plans Are Redefining the HIM…
Risk-adjusted payment is no longer just a Medicare Advantage concern—commercial insurers are reshaping how coding, documentation, and compliance strategies must evolve.
ICD-10-CM FY 2026 Code Updates: What Coders Need to Know Before October 1, 2025
Effective for discharges and encounters from October 1, 2025, through September 30, 2026, this release introduces 487 new diagnosis codes, 38 code revisions, and 28 code deletions.
Revenue Cycle Services for Healthcare Providers
On August 13, 2025, the Centers for Medicare & Medicaid Services (CMS) released updated Medicare Part B payment allowance limits for the 2025-2026 influenza season. These rates are effective August 1, 2025, through July 31, 2026, and reflect…
Medical Coding Company Updates
The Centers for Medicare & Medicaid Services (CMS) released its fourth quarter update to the HCPCS Level II code set, impacting healthcare providers who report services, supplies, drugs, and equipment.
Risk Adjustment Data Validation (RADV) Audits: Turning Compliance into…
In this article we break down what makes Risk Adjustment Data Validation (RADV) audits so challenging, what’s changing, and how health plans can flip the script from reactive compliance to proactive strategy.
CMS Halts Eight MIPS Improvement Activities for 2025: What Providers Need to…
This decision, rooted in the Improvement Activities Suspension Policy finalized in the CY 2021 Physician Fee Schedule Final Rule, signals a possible shift in CMS’s long-term priorities for clinician performance evaluation.
Medicare and Medicaid Billing Updates Explained for Healthcare Providers
A comprehensive breakdown of upcoming Medicare and Medicaid billing updates. Information covers policy changes, revenue impact, and compliance requirements.
CCAI: Senior Health Plan for Medicare and Medicaid in Illinois
CCAI, a subsidiary of Family Health Network, provides person-centered care for Medicare and Medicaid populations in Illinois, guided by national experts.
Physicians Billing Complexity - Medicare v/s Medicaid
Physicians need to know well the points while processing the Medicare and Medicaid billing of patients covered under these
Ambulance Billing: Origin and Destination Codes
Understanding the proper coding of ambulance transport origins and destinations is an important ambulance billing best practice, in order to comply with Medicare and Medicaid guidelines.
Billing for Medicare Diabetes Prevention Program
The Centers for Medicare and Medicaid Services (CMS) have expanded its Medicare Diabetes Prevention Program (MDPP) nationwide.
Billing Practices for Medicare Diabetes Prevention Program Services
The Centers for Medicare and Medicaid Services (CMS) have expanded its Medicare Diabetes Prevention Program (MDPP) nationwide. Traditional healthcare providers and community-based organizations can enroll as Medicare suppliers of health behavior…
Medicare & Medicaid: Key Differences in Prior Authorization
Learn about key differences in Medicare and Medicaid prior authorization including rules, timelines, and state regulations, to improve approval rates.