Billing Compliance

CMS blocked $1.6 billion in suspect lab payments, and new rates land Jan. 1. Ten checks to run on your in-office lab first.

Federal fraud flags start with peer comparison, and the first consequence is a payment hold. Here's what you need to check in your own claims data.

CMS says its Medicaid Fraud War Room stopped $203 million and flagged 50 providers in 88 days, all surfaced by billing analytics.

AI adoption in physician practices is accelerating. The contracts, however, often get less scrutiny than the sales pitch.

Coding success for incident-to billing can be easy with a solid foundation.

Stay updated on flu shot billing requirements to optimize revenue, avoid claim denials and ensure compliance during the 2025-2026 season.

MRO Senior Regional Director of Sales Melissa Hibbert outlined how outsourcing routine but high-stakes tasks can reduce administrative strain.

Master key strategies — from check-in protocols to appeal tactics — that reduce billing errors and improve collections in today’s complex environment.

Hidden fees, rising costs and inefficiencies could be cutting into your bottom line.

Here are six basic requirements to meet incident-to guidelines and get properly reimbursed for your care.

To minimize potential liability for coding compliance issues, providers should go back to the basics, and familiarize themselves with high-risk areas for coding and billing audits and enforcement.

Four changes that can improve the value of quality metrics.

Here are six basic requirements to meet incident-to guidelines and get properly reimbursed for your care.

Here are six basic requirements to meet incident-to guidelines and get properly reimbursed for your care.

The risk of malpractice and negligence is hurting the medical billing industry. Here’s a brief article talking about various risks involved with these threats to practices, clinics, and coders.

Don’t let your Medicare Part B reimbursement for advanced imaging be impacted by the CMS Mandate taking effect on January 1, 2022!

Compliance measures can assist healthcare industry participants avoid potential liability, whether civil or criminal, under the False Claims Act.

A compliance program is important in this day-and-age, thanks to increasing amounts of healthcare fraud as well as payment reform.

HHS-OIG items of interest for providers.

The National Health Care Anti-Fraud Association estimated that healthcare fraud costs the nation $68 billion annually.

Providers will benefit most from well-tailored RPM programs designed within the current requirements that also have the means to be flexible as requirements inevitably shift.

What the new HL7 interoperability standards means for providers.

DHS profit distribution compliance may require modification of physician contracts, compensation policies, and other documentation within the practice

Few employers readily assume responsibility in initial contracts — make sure you read the fine print and negotiate.

To avoid potential conflict, patients should be provided advance notice of your policy to avoid surprise and embarrassment.