Medicaid

The CMS-0057 rule regulates health plans, not practices, but administrators are the ones who have to get the EHR and billing vendor conversations right.

Most Medicaid improper payments trace to missing paperwork, not fraud. These nine checks close the gaps auditors keep finding.

Madison Hynes of MGMA explained what practice leaders should watch as electronic prior authorization and Medicaid work requirements arrive Jan. 1.

Medicaid work requirements, new remote monitoring rules and an electronic prior authorization deadline all land Jan. 1, and that's only part of what MGMA told practice leaders to watch.

Conifer's 1,037 layoffs and an intensifying Medicaid fraud crackdown are squeezing practice revenue cycles from both sides.

Medicaid work requirements hit the front desk Jan. 1, 2027. What changes at check-in, in billing and when coverage lapses mid-treatment.

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

On December 2, 2020, CMS published new provisions and exemptions related to the Stark Law (85 Fed. Reg. 77492) and HHS-OIG published new provisions and safe harbors related to the Anti-Kickback Statute (AKS) (85 Fed. Reg. 77684.

Code accurately with the appropriate documentation to substantiate medical necessity.

Only a quarter of Medicare and Medicare Advantage recipients receive an annual wellness visit.

If providers fail to follow these new rules, claims will be denied, and eventually, those who are outliers on adherence to appropriate use criteria will be subject to prior authorization.

Most physician compensation structures must comply with Stark laws. The danger is that practices may be in violation without realizing it, putting themselves at risk of fines and exclusion from Medicare and Medicaid.

New guidance unveiled this week would allow states to impose work requirements on Medicaid recipients, but one physician advocacy group is not on board.