Billing and Claims

Medicare could have saved over $200 million in payments for definitive drug testing services between 2016 and 2020 if proper program safeguards had been in place, according to a recent audit report by the Office of Inspector General (OIG).

Providers are more frequently billing for outpatient evaluation and management services with high-level codes, which has led to higher outpatient spending, according to a recent study.

HHS released a policy roadmap for providers ahead of the public health emergency (PHE) conclusion. The roadmap details policies that will simultaneously end with the PHE, as well as flexibilities that have been extended for various time periods.

CMS recently published an FAQ to address the products, providers, and billing practices associated with drug waste modifiers -JW and -JZ.

As we start 2023, one of the biggest questions is the fate of the COVID-19 public health emergency declaration (PHE).

Look ahead to a bright future in revenue integrity.

Ronald Hirsch, MD, FACP, CHCQM, CHRI, shares tips for preparing for the end of emergency waivers.

Learn how CMS’ changes will affect hospital reimbursement.

Ensure you’re complying with new rules for billing and coding.

Brush up on hospital compliance requirements with surprise billing rules.