Social Media Ideas for Hcc Coding Compliance

Complete Health to pay $14.1M in Medicare Advantage coding misuse allegations settlement

The settlement resolves allegations from 2020 to 2023 that the company submitted HCCs that were "not clinically valid" or not supported by medical records or treatment plans.

Compliance Program Lessons from the Complete Health Settlement

On August 4, 2026, the United States Department of Justice (“DOJ”) on behalf of the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services announce...

Evaluation and Management Tip of the Month

The AOA Coding and Reimbursement Committee supports the AOA's strategic direction to develop and value procedural (CPT), diagnostic (ICD-10) and supply codes (HCPCS). The committee...

Lessons from CHIMA: Coding for Clinical Care Instead of Reimbursement

Health information management in Canada looks completely different without the constant friction of claims rejections and payer battles. By coding strictly for patient care rather...

Complete Health Partners Holdings $14M FCA Settlement: Medicare Advantage Risk-Adjustment Fraud

Complete Health Partners Holdings, a Jacksonville-based management services organization overseeing affiliated provider groups in Florida, Alabama, and Colorado, has agreed to pay...

Revenue-Protecting Outsourced Medical Coding Services for Growing Healthcare Organizations

Healthcare organizations such as hospitals and clinics consistently provide excellent medical services. People can count on healthcare organizations to get […] Magellan Solutions -...

Regular expressions for HCPCS codes

Since I revisited my old post on ICD code matching, I thought I’d revisit by post on HCPCS codes too. HCPCS stands for Healthcare Common Procedure Coding System, and is pronounced...

OIG’s New CIA Template Enhances Compliance Obligations for Health Care Organizations

On April 30, 2026, at the Health Care Compliance Association’s 2026 Compliance Institute, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) intro...

FQHCs - The Expanding Landscape of Medicare Billing Outside of PPS for Care Management Services

Summary: Medicare has steadily expanded the services that Federally Qualified Health Centers can bill outside the Prospective Payment System, creating new reimbursement opportunit...

The Code Gets You Paid — The Variant Gets You Treated

The between a code that satisfies a payer and the information a physician needs to treat a person, is what nearly every healthcare AI tool is racing past. As we push these systems...

American Medical Association's New AI Billing Codes Draw Nursing Opposition and Raise Broader Questions about AI Reimbur...

Client Alert: A New Era for Maternity Billing—The Current Procedural Terminology Code Overhaul Reshaping Obstetric Reimb...

Not All Noninvasive Imaging Technologies Are Evaluated the Same by Payers

As noninvasive tests for assessing liver disease continue to evolve, it can be tempting to assume that technologies designed to assess the same clinical conditions are evaluated th...

CMS's Revised Medicare Overpayment Rule: What Healthcare Providers Need to Know

Why US Hospitals Drown in Claims While Canada Misses Clinical Data

US hospitals are fighting a massive wave of claims denials and billing complexity. Meanwhile, Canadian facilities are losing critical clinical data due to incomplete physician docu...

Readers Write: Governing AI for HIPAA Compliance: Building a Secure AI-Driven Compliance Program

Governing AI for HIPAA Compliance: Building a Secure AI-Driven Compliance ...

More Than a Billing Requirement: CMS Turns Medicare Enrollment into a Program-Integrity Tool

Key Updates CMS has proposed a significant expansion of its Medicare provider enrollment and program-integrity authorities through the Calendar Year 2027 Home Health Prospective P...

Health Provider News

NATIONAL CMS Medicaid fraud unit flags 50 providers, $203M in payments CMS’ proposed remote patient monitoring ban, explained D.C. appeals court sides with HHS in 340B drug discoun...

Healthcare HR Compliance Listening Study

New Research  ·  HRMorning + Mitratech  ·  2026 What Surfaced About Compliance Across 2,867 Healthcare HR Conversations. Without Being Asked. We analyzed vendor-evaluation calls th...

Developing Country-Specific Charlson Comorbidity Index Mappings for Use With German Administrative Data: Methodological...

Background: The Charlson Comorbidity Index (CCI) is widely used to quantify comorbidity burden in observational research. Applying it to real-world data requires accurate Internati...

How Pharmacy Medical Coding Services Help Specialty Pharmacy Providers Speed Up Insurance Reimbursements

Patients who have cancer, rare diseases, and autoimmune disorders often face high costs of treatment and medication adherence issues. The […] Magellan Solutions - Call Center | BPO...