CMS Wants to Know Who’s Actually Watching.
Buried in the CY2027 Part B provisions: RPM and RTM would have to be furnished by direct employees of the billing practice. Comments close 14.
Read More CMS’s Fraud AI Doesn’t Know the Difference.
CMS's Fraud Defense Operations Center flags volatility — billing that moves faster than the baseline. That is also exactly what a legitimate practice looks like.
Read More CMS Quietly Put One Office in Charge.
CMS created the Office of Health Technology and Products in a four-page Federal Register notice. It is a jurisdiction change — and jurisdiction changes hit.
Read More Everyone’s Mad About the Conversion Factor Cut..
The CY2027 Physician Fee Schedule headline is the conversion factor cut. The G2211 modifier swap and the 50% modifier 25 reduction are logic changes —.
Read More The Senate Just Settled One WISeR Fight..
From 1 October, RHCs and FQHCs can no longer bill telehealth under G2025. It touches charge masters, scrubbers and denial workflows at once — and.
Read More Everyone’s Still Fighting Over WISeR’s Funding. Almost.
Gold-carding went live in Washington on 6 July. It is not a courtesy exemption — it is a 90% affirmation bar most practices in WISeR.
Read More Everyone Covered the WISeR Vote. Almost Nobody.
The Senate vote on WISeR was theatre. The July 1 Medicare Advantage decision clock — 72 hours urgent, 7 days standard, every MA plan in.
Read More The Denial Rate You Reported Isn’t the.
Payers now publish their own prior-auth metrics. The data is aggregated to the point of meaninglessness — and a payer can report an improving rate.
Read More The Rule Worked. Denials Still Went Up.
Denial rates are up 31% year over year, six months into the rule meant to fix this. The bottleneck did not disappear — it moved.
Read More Faster Prior Auth Is the Law Now..
CMS's prior authorisation rule is already live in part, with electronic prior-auth APIs due January 2027. A faster pipe does not care which direction the.
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