Billing and reimbursement

With risk adjustment’s impact on reimbursement, review tips for accurate coding, compliant documentation, and timely responses.

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

CMS is seeking feedback on potential policy changes ahead of the third cycle of negotiations under the Medicare Drug Price Negotiation Program.

Learn how HIM professionals can leverage data related to social determinants of health (SDOH) to improve patient care and secure proper reimbursement.

Even though Congress didn’t fully unleash telehealth services, instead extending the long-running telehealth waivers through September, making your telehealth services a permanent offering can improve your practice’s financial health.

Analyze CMS' recent coverage expansion for hepatitis B vaccines and their administration.

CMS recently issued a final rule detailing policy and technical changes to Medicare Advantage (MA) and Part D programs for contract year (CY) 2026. 

Analyze key provisions in the 2026 Inpatient Prospective Payment System (IPPS) proposed rule to understand potential updates to Medicare inpatient coding and billing.

Recent data shows that all improper payments for bacterial culture lab tests can be traced back to insufficient documentation. Review CMS' provider compliance tip to prevent denials. 

Practices upped their use of modifier 59 (Distinct procedural service) in recent years, adding nearly 1 million 59-appended claims to the most frequently reported same-day procedural codes.