Predicting coding patterns using the HCC risk scores can be a valuable endeavor. EDITOR’S NOTE: Longtime RACmonitor contributing correspondent Frank Cohen, a senior healthcare analyst,
CMS is eliciting comments on MA plans abusing basic Medicare benefits. EDITOR’S NOTE: Patients and healthcare providers can present their personal experiences, devoid of personal
New deductibles and payment rates lead to new patient financial obligations for 2023. EDITOR’S NOTE: Listen to Dr. Ronald Hirsch’s live reporting Monday on Monitor
The final rules become effective Jan. 1, 2023. Amid this election season, the Centers for Medicare & Medicaid Services (CMS) has published final rules for
EDITOR’S NOTE: Terry Fletcher reported this story on Talk Ten Tuesdays earlier today. Her story is part of growing evidence of misdeeds by some Medicare
OIG report: widespread and persistent problems related to inappropriate denials of services and payment by Medicare Advantage Organizations. Organizations continue to find the management of
Problem lists are a problem because often they are not updated. Over the last year, we have heard much about Medicare Advantage (MA) health plans
Often, the rules do not make sense from a compliance or best-practices perspective. Medicare has a reputation of putting out policy that many feel is
The volume of Medicare beneficiaries has been slowing growing while the distribution of Medicare plans is quickly changing. Medicare provides federal healthcare coverage for Americans
Doing what’s right is never wrong! Over the last six months we’ve all read the disappointing stories about some of the missteps (intentional or unintentional)
There is currently a bill in Congress to raise the caps by 17,000. When I was just a young cub in healthcare, Medicare performed audits
There is currently a bill in Congress to raise the caps by 17,000. When I was just a young cub in healthcare, Medicare performed audits
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