The Office of Inspector General (OIG) just released a critical audit revealing that 77% of trauma team activation claims submitted to Medicare between 2020 and 2022 did not meet federal requirements. Key Findings: $2.4 billion in estimated unallowable charges. 107 out of 125 sampled claims failed to meet Medicare criteria. Common issues included: No prehospital notification. Trauma
The October 1st implementation date for the 2026 ICD-10-CMS and ICD-10-PCS changes are quickly approaching. Do you have an implementation plan? The updates bring both condition and technology specific changes and broader coding clarifications for ICD-10-CM in which clinical and coding staff should be aware. ICD-10-CM Key Highlights: New guidance
The Centers for Medicare & Medicaid Services (CMS) has released the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule (CMS-1834-P). This sweeping proposed rule outlines new payment policies, transparency requirements, and quality program updates that will shape how outpatient care is delivered and
The Centers for Medicare & Medicaid Services (CMS) has issued the CY 2026 Medicare PFS Proposed Rule (CMS-1832-P), and it brings major updates to payment policies under Medicare Part B. Here’s what you need to know: Separate Conversion Factors: Beginning in 2026, two conversion factors will apply—one for qualifying alternative
The Centers for Medicare & Medicaid Services (CMS) has issued “Updated Hospital Price Transparency Guidance” (May 22, 2025) which outlines new policies pursuant to Executive Order 14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” CMS aims to ensure hospitals submit accurate, actionable pricing
The Centers for Medicare & Medicaid Services (CMS) has announced a major expansion of its audits of Medicare Advantage (MA) plans. Effective immediately, CMS will audit all eligible MA contracts for each payment year in all new audits and aims to complete audits for 2018–2024 by early 2026. This initiative
