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News
UnitedHealthcare cuts prior authorization from 1,700 codes
1+ week, 4+ day ago (599+ words) The codes span a broad range of services across multiple specialties, including oncology and cardiology...Now, UnitedHealthcare has released detailed lists of the CPT codes, five-digit codes that represent medical...The cuts include more than 800 codes for UnitedHealthcare’s commercial plans,…...
Group Sues AMA Seeking Transparency Over Medicare Billing Codes
3+ week, 5+ day ago (189+ words) American Medical Association in an effort to get more transparency over the association’s billing codes...PatientRightsAdvocate.org hopes to republish the codes online and allow the public to search them free...which has pushed for health care transparency, is challenging…...
A billing code was supposed to incentivize relationship-based primary care for Medicare patients.
2+ week, 3+ day ago (237+ words) The G2211 code represents one of the latest attempts, and the most recent one for which we have data....While the PCPs I spoke with dutifully bill the code with each relevant visit, some bemoaned the modest...
Corporate Practice of Medicine: Vertical Alignment and Medicare Advantage Risk Coding - August 27, 2026
2+ week, 3+ day ago (66+ words) Seminar - September 29, 2026 2:00 PM - 3:30 PM Pacific Contact Danielle Iniguez if you would like to attend the seminar via Zoom or meet with the speaker in person. Verna and Peter Dauterive Hall (VPD), 116 LA Campus 635 Downey Way Verna & Peter Dauterive Hall (VPD)…...
‘Future Regulation’: MDS Audit Discrepancies Highlight Nursing Homes’ Record-Retention Gaps
2+ week, 6+ day ago (769+ words) Image by ammcintosh1 from Pixabay Nursing home validation audits so far show MDS coding gaps tied to...In some cases, the facility may have coded the MDS appropriately, but auditors cannot validate the coding...And so, accurate coding alone may not…...
Blue Cross Blue Shield lowers payment for therapists, pediatricians under new ‘downcoding’ policy
2+ week, 4+ day ago (1270+ words) The BCBS claims at the center of this change are for the “bread and butter” codes physicians use for...feeling sick and you go in, they’re going to bill you for an [evaluation and management services] code...
Monogram Health to pay $2.4 million in Medicare Advantage false claims settlement
2+ week, 6+ day ago (283+ words) of Medicare Advantage risk-adjustment practices is continuing as regulators focus on how diagnosis coding...based in Tennessee, is agreeing to pay $2.4 million to resolve allegations that unsupported diagnosis codes...Monogram Health agreed to pay $2.4 million to settle allegations it submitted…...
Monogram Health to pay $2.4M to settle Medicare Advantage upcoding allegations
2+ week, 4+ day ago (303+ words) health company, overcharged Medicare through contracts with Cigna and Humana by inflating diagnostic codes...Diagnosis codes associated with more serious conditions raise a beneficiary’s risk score — and the insurer...The codes increased beneficiaries’ risk scores and caused the CMS to…...
UnitedHealthcare's 1,700 Prior Auth Cuts Draw Muted Applause
1+ week, 4+ day ago (386+ words) The list of codes was announced in UHC's monthly Network News bulletin....The impact of removing 1,700 codes from prior authorization requirements is likely smaller than it suggests...also not disclosed how many actual authorization requests, patients, or dollars of spending…...
Medicare Advantage Provider Monogram Health Agrees to Pay $2.4 Million to Settle False Claims Act Lawsuit
2+ week, 6+ day ago (560+ words) resolve allegations that they violated the False Claims Act by causing the submission of false diagnosis codes...“When companies submit false diagnosis codes, they unlawfully exploit a system built to support vulnerable...The submission of these diagnosis codes resulted in…...