The Balance Sheet: Informing Your RCM Decisions

The claims issues log below includes the status of claims processing issues that have been identified. We are actively working...

PURPOSE:   The purpose of this bulletin is to issue updated handbook pages that include the requirements for prior authorization and...

Elevance Health (Anthem) will begin penalizing healthcare facilities in 11 states starting Jan. 1, 2026, for using out-of-network providers for...

Cigna and Aetna are drawing provider backlash for new payment policies that reduce reimbursements. Cigna is automatically "downcoding" six Evaluation...

In the last few years, the Centers for Medicare & Medicaid Services (CMS) has accelerated its long-term effort to strengthen...

The financial and reputational health of an urgent care practice depends on one simple principle: bill accurately and compliantly. Yet...

In anticipation of possible Congressional action, CMS has instructed all Medicare Administrative Contractors (MACs) to continue to temporarily hold claims...

To all providers:  On May 14, 2025, four PO boxes changed from the processing center in St. Louis, MO, to...

NCCI Alert: COVID-19 Vaccine Administration Edit Revision  Some providers may have 90480 claims denied when billed in conjunction with G0008,...

In the absence of a federal budget bill or continuing resolution, the government shut down on October 1, 2025, many...

For combination tests that are read visually, CPT code 87812 QW will be effective January 1, 2026. Until then, laboratories may bill CPT...

Something that we see frequently is multiple diagnosis codes related to the same body area being selected and billed on...