On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (CMS-4201-F) regarding the Medicare Advantage (MA) and Part D programs. The Final Rule includes changes related ...

On February 6, 2024, the US Centers for Medicare & Medicaid Services (CMS) released a set of frequently asked questions (FAQs) related to Medicare Advantage (MA) coverage criteria and utilization ...

If you have a bacterial infection, you need to take antibiotics. If health care providers need to determine that you have a broken bone, you’ll need to have an X-ray. Those are some examples of ...

As recovery audit contractors set their sites on medical necessity of inpatient stays, hospitals enter a hazy area of compliance. RAC consultants say Medicare definitions of what constitutes inpatient ...

There are many steps that inpatient hospital providers can take to avoid denial of their claims when submitting Medicare fee-for- service claims. The Centers for Medicare & Medicaid Services (CMS) ...

Though you may consider the RACs to be like bounty hunters, the RACs are certainly NOT pirates - CMS will be holding them to the same rules that apply to current reimbursement administrators, carriers ...

Medicare limits coverage to treatments, services, and supplies deemed medically necessary. If Medicare does not consider a service medically necessary, it will typically not cover it. Medicare covers ...

Q: What’s new with wound care documentation and CMS guidelines? A: The Center for Medicare & Medicaid Services recently issued modifications in Local Coverage Determinants that can potentially affect ...