Medical Payers & Insurance Companies

RADs with bi-level capability, with or without a backup rate feature, are devices that use a noninvasive interface (mask) to deliver a higher level of airway pressure when the patient inhales compared to when they exhale. A backup rate feature enables the device to provide a prespecified respiratory rate if the patient’s spontaneous respiratory rate decreases below a set number. HMVs deliver a predetermined amount of air with each breath and typically have more monitoring, safety, alarm, and backup power features (such as batteries) than RADs.

In February 2024, HHS published a final rule modifying the Part 2 regulations to implement section 3221 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to increase coordination among providers treating patients for SUDs, strengthen confidentiality protections through civil enforcement, align certain Part 2 requirements with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules, and enhance integration of behavioral health information with other medical records to improve patient health outcomes. The final rule provides the public with the ability to file complaints alleging violations of the Part 2 confidentiality provisions, requires Part 2 programs to provide notification of breaches of Part 2 records, and implements in regulation HHS’s civil enforcement authority, including the potential for civil money penalties for violations of Part 2.

Federal contractors – Recovery Audit Contractors (RACs) and Unified Program Integrity Contractors (UPICs) – have increasingly targeted wound care claims, particularly involving expensive skin substitutes billed under Medicare Part B. In 2023 alone, over $1.6 billion was spent on these products, prompting heightened audit activity from Qlarant, Novitas, and others. This...

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Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation...

Today, in utilization news, there is a warning to any surgeons who may be reading this – or anyone who works with surgeons. You may see new efforts by the Centers for Medicare & Medicaid Services (CMS) to lower your fees in coming years. We have all heard about...

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Considering the increase in measles cases in the United States and globally, it is a great time to review how we code for this condition. According to Centers for Disease Control and Prevention (CDC) data, updated on May 30, so far this year we have had 1,088 domestic measles...