Insights
Notes on reimbursement, audits, coding, and the rules that move a healthcare revenue cycle.
January 21, 2026
The healthcare system depends on trust—trust that professionals are who they say they are, that patient records reflect the truth, and that powerful medications are prescribed only when medically…
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January 21, 2026
Effective immediately, CMS’ A/B Medicare Administrative Contractors (MACs) are withdrawing the Local Coverage Determinations (LCDs) for Skin Substitute Grafts/Cellular and Tissue-Based Products…
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January 21, 2026
We have brought this sought-after workshop online, which has been in high demand. To keep the workshop valuable and allow optimal interaction, we have limited the space. In today’s complex…
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January 7, 2026
Implementation of the Wasteful and Inappropriate Service Reduction (WISeR) Model, which tests using enhanced technologies including AI to reduce clinically unsupported care in Original Medicare…
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January 1, 2026
CMS is continuing its effort to better pay for the complexity of longitudinal care by expanding use of HCPCS add-on code G2211—a change that will be especially relevant for clinicians providing…
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August 11, 2025
Bloom Care LLC, which operated urgent care clinics across Idaho and New Mexico during the COVID‑19 pandemic, has paid $3 million to resolve allegations under the False Claims Act. According to the…
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August 11, 2025
Starting October 1, 2025, Cigna Healthcare® will implement a sweeping new reimbursement policy that could directly impact how physicians are paid. Under the Evaluation and Management Coding…
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August 8, 2025
In a significant ruling for the healthcare and insurance industries, the U.S. Court of Appeals for the Sixth Circuit handed down a decision on July 1, 2025, in AMISUB (SFH), Inc. v. Cigna Health…
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August 8, 2025
In a significant development in the ongoing battle against healthcare fraud, Forefront Dermatology S.C. and Henghold Surgery Center LLC have agreed to pay a combined $847,394 to resolve…
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