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Autonomous coding is moving from pilot to production at more health systems, and revenue integrity teams are often brought in late. Yet many of the decisions that determine whether a deployment protects revenue or leaks it belong to revenue integrity: where...
Hospitals will be facing lower reimbursement for certain services at expected off-campus provider-based departments (PBD), 340B drugs, and non-drug items and services, according the 2027 Outpatient Prospective Payment System (OPPS) final rule.
CMS finalized additional cuts to the conversion factor (CF) and new modifiers to replace Healthcare Common Procedure Coding System (HCPCS) code G2211, according to the 2027 Medicare Physician Fee Schedule (MPFS) final rule.
A new Office of Inspector General (OIG) data brief highlights potential weaknesses in CMS’ and Medicare Administrative Contractors’ (MAC) oversight of Part B outpatient drug billing.
Revenue integrity staff at physician offices must follow CMS billing guidelines for ITVISMA®, a new gene therapy drug approved to treat certain patients with spinal muscular atrophy.
CMS published the October 2026 update to the Outpatient Prospective Payment System (OPPS), which includes changes to codes, status indicators, and payment rates.
