News & Analysis

May 28, 2025
News & Insights

Learn how CMS plans to enhance its risk adjustment data validation auditing efforts for Medicare Advantage (MA) plans and recover overpayments.

May 28, 2025
Medicare Insider

This week’s Medicare updates include new guidance on hospital price transparency requirements, updated HCPCS code lists for various discarded drug policies, and more!

May 20, 2025
Medicare Insider

This week’s Medicare updates include draft guidance for the third cycle of the Medicare Drug Price Negotiation Program, the July 2025 HCPCS quarterly update file, and more!

June 19, 2024
Briefings on APCs

Make sure staff who handle audit requests understand when a missing signature should — or should not — trigger an automatic denial of your claims or prior authorization requests. Recent guidance from CMS clarifies how auditors should proceed when a medical record lacks a signature.

March 27, 2024
Case Management Monthly

A final rule issued by CMS in February includes several changes to Medicare Advantage (MA) regulations aimed at ensuring health equity, quality, and safety.

September 20, 2023
Briefings on APCs

When writing appeals for healthcare denials, being proactive and thorough can significantly improve the chances of overturning the denials.

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