On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued their final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (MPFS) beginning on January 1, 2019.READ MORE
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The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is out with a report analyzing the rate Medicare Advantage plan claim denials are successfully appealed. According to the OIG, over 75 percent of appealed denials are successfully overturned.READ MORE
Beginning with dates of service on or after Jan. 1, 2019, UnitedHealthcare, aiming to minimize out-of-pocket costs for its members, will review the site of care during their Outpatient Radiology Prior Authorization process. This is being instituted, many believe, to allow UHC to direct patients away from outpatient hospital settings and into outpatient freestanding imagingREAD MORE
Recovery audit contractors are hoping a new report on their past success recovering money for Medicare will cause CMS to reverse course on its decision to limit the number of claims they can review.READ MORE
CMS is proposing to pay a standard reimbursement rate for E/M levels 2 through 5. CMS is also proposing many changes to the documentation requirements for E/M visits.READ MORE