The Cautionary Tale of CMS’s New Policies for Global Surgery Payment Accuracy January 10, 2025 | Shannon O. DeConda, CPC, CPMC, CEMC, CEMA, CPA-EDU, CRTT, CPA-R The Centers for Medicare & Medicaid Services (CMS) continues to refine policies to address the evolving needs of the healthcare system, with an eye on accuracy and fairness…
Insurance Discrimination – Against the Provider Author: Jeana M. Singleton, Esq. When the concept of “insurance discrimination” rears its ugly head, we often think of it in the context of when an insurance company treats some people differently than others based on protected classes, such as race, national origin, sex, or religion. Sometimes, this type…
November 29, 2024 | By Terry A. Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM, PACS Telehealth 2025: The Final Rule CMS issued the calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS) final rule on Nov. 1, 2024, publishing guidance that will have providers and coders scratching…
December 13, 2024 | By Rhonda Granja, B.S., CMA, CPC, RMC, CMC, CMOM, CMIS As we navigate this complex world of coding, every year we prepare for changes, updates, new codes as well as deletion of codes. For 2025, there are 420 overall updates that are in the CPT 2025 code set. Those include…
December 22, 2023 | By: Edward Baker, Of Counsel | Lieff Cabraser Heimann & Bernstein On September 30, 2023, the U.S. Department of Justice announced a $172 million False Claims Act (FCA) settlement with Cigna relating to the submission of invalid HCC diagnosis codes to CMS in order to increase Medicare Advantage member risk scores, and therefore,…