News & Analysis

March 3, 2021
News & Insights

CMS is reminding organizations of Medicare Secondary Payer (MSP) billing and appeal processes after the agency inappropriately denied some claims.

March 1, 2021
Case Management Monthly

As of May 1, UnitedHealthcare, the largest health insurance company in the United States, will be switching from using Milliman Care Guidelines (MCG) to InterQual.

February 3, 2021
Medicare Insider

This week’s Medicare updates include a notice about reprocessing certain drug claims that were rejected in error, the latest version of the Medicare beneficiary COVID-19 data snapshot, a table on MAC pricing for COVID-19 testing, and more!

February 1, 2021
Briefings on APCs

In a year of unprecedented disruption and uncertainty, coding productivity managed to hold steady, according to the results of our 2020 Coding Productivity Survey. Learn how facilities adapted and how yours compares.

January 13, 2021
HIM Briefings

Organizations continue to struggle with denials for conditions such as sepsis and pneumonia. Review your processes and then apply these expert tips to help turn the tide.

January 1, 2021
Briefings on APCs

Section 1862 (l) and Section 1869 (f)(2)(B) of the Social Security Act (the Act) sets forth general procedures to develop and evaluate Medicare coverage determinations that are either adopted nationally by CMS or created and applied locally by a Medicare Administrative Contractor (MAC) within the MAC’s own jurisdictional boundaries.

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