The five regional Recovery Audit Contractors (RACs) are ramping up their automated and complex reviews starting this month. The Centers for Medicare & Medicaid (CMS) Medicare Fee for Service (FFS) audit program awarded contracts in October 31, 2016 ....

The Office of Inspector General (OIG) Work Plan for Fiscal Year 2017 provides useful guidance for healthcare providers and payers to monitor their claims for potential fraud and quality of care concerns. The Work Plan (at https://oig.hhs.gov/reports-and-publications/workplan/) details areas where OIG will focus their review efforts by type of provider.

Context 4 Healthcare, Inc., a leading provider of healthcare compliance and pricing solutions, announces today the implementation of the Skilled Nursing Facility Medicare Prospective Payment System (PPS) as the latest addition to Context’s DecisionPoint Pricing System™. This latest addition further expands the DecisionPoint Pricing System, the first solution in the healthcare industry to provide automated, real-time access to accurate Medicare fees for pricing healthcare claims duri ...

The Centers for Medicare & Medicaid Services (CMS) has established 2 new HCPCS modifiers that will affect reimbursement rates for the year 2017. The first new HCPCS modifier is FX, which is X-ray taken using film. The Consolidated Appropriations Act of 2016 (Section 502(a)(1)) Medicare Payment Incentive for the Transition from Traditional X-Ray Imaging to Digital Radiography and Other Medicare Imaging Payment Provision amends the Social Security Act by reducing the payment amounts under th ...

Context 4 Healthcare, Inc . , a leading provider of healthcare compliance and pricing solutions, announces today the implementation of the End Stage Renal Disease Medicare Prospective Payment System (PPS) as the latest addition to Context’s DecisionPoint Pricing System™. The DecisionPoint Pricing System is the first solution in the healthcare industry to provide automated, real-time access to accurate Medicare fees for pricing healthcare claims during adjudication. When health plan ...