Why the Office of Personnel Management Needs Access to Government Employee Health Plan Claims Data
Without knowledge of the exact amount providers billed and middlemen charged in fees, OPM can’t fix payment discrepancies.
The Kaiser Settlement Should End the Guesswork in Medicare Advantage Oversight
The settlement demonstrates that enforcement risk is real and substantial, but it also highlights an opportunity. Medicare Advantage oversight does not require years of new rulemaking or experimental pilots because the technical capability to validate documentation at scale already exists and can be deployed today.
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The Power of Real World Data to Study Women’s Health at Scale
Veradigm examines key clinical trends, comorbidity profiles, and treatment trends across adolescence, reproductive years, and peri-/post-menopause. Download it today!
Navigating Capital Audits: Key Risks and Best Practices for Nursing Homes
Capital audits can create financial pressures for facilities. However, with proactive risk mitigation, nursing homes can safeguard their financial stability and ensure continued compliance.
Medicare Advantage Audit Ready with AI
Adding generative AI and other AI tools to coding and chart review practices streamlines a complex process and better positions plans for risk adjustment audits.
How tech can help solve the overpayments problem in healthcare RCM
When CMS overpays for services, providers and commercial payers are responsible for paying the agency back, and at times, they are on the hook for millions of dollars. But technology can help healthcare stakeholders catch the mistakes that lead to overpayments, thereby reducing unnecessary costs.
Are you prepared for a post-pandemic surge of PDPM audits?
CMS recently revealed that the Patient-Driven Payment Model – intended to be revenue-neutral as compared to the previous payment model – increased reimbursements to SNFs last year by more than $1.7 billion, raising the specter of potential payment reviews around the corner.
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Top 7 Modern AI-Powered EAP Providers for Global Workforces in 2026
Discover the top AI-powered EAP providers for 2026. Compare platforms like Kyan Health and Spring Health on triage speed, global reach, and clinical quality to transform workforce wellbeing.
What providers need to know about OIG’s plans to audit telehealth services
The Office of the Inspector General will audit Medicare Part B telehealth services to detect potential vulnerabilities and ensure compliance with regulatory requirements. To prepare, providers must first take stock of their programs and conduct audits of their own, experts say.