As audits and downcoding become more common, audit defense isn’t a back-office function. It’s a financial imperative.” — Moghis Uddin, CEO of AlethianAI ...

Like many medical students, I had a difficult time choosing my specialty. I vacillated between a surgical, more procedure-oriented field and one focused on medicine. In 2003, and probably still today, ...

After proposing meaningful reforms to reduce Medicare Advantage (MA) overpayments in January, the Centers for Medicare & Medicaid Services (CMS) reversed course this week to instead propose further ...

A Pennsylvania health system filed suit this week against Aetna, challenging a policy around "downcoding" that has drawn ire from providers. Philadelphia-based Jefferson Health said in a complaint ...

MedPAC answers the dollars-and-cents question—how much more Medicare pays MA plans due to favorable selection and upcoding than it would spend if MA beneficiaries were in traditional ...

Jefferson Health sued Aetna Monday over a controversial new policy that reduces payments for hospital stays for Medicare Advantage patients that Aetna decides aren’t sick enough to qualify for full ...

The Centers for Medicare & Medicaid Services April 2 issued a proposed rule for the skilled nursing facility prospective payment system for fiscal year 2027. The proposal would increase aggregate ...

The Centers for Medicare & Medicaid Services has proposed a 2.4% Medicare pay hike for fiscal 2027 and is developing ways to eliminate payment “creep” under the Patient Driven Payment Model. The 2027 ...

In recent seasons, college basketball has seen a number of big men switch teams and have an immediate impact, with Purdue's Oscar Cluff and North Carolina's Henri Veesaar serving as prime examples ...

Anyone working in skilled nursing today understands how much is being asked of providers. Staffing challenges, reimbursement changes, survey pressure and quality expectations all collide at once.