Payment Integrity & Compliance
Expert articles and analysis related to payment integrity & compliance.
AI Summary — Last 7 Days
In the past week, the evolving landscape of Medicare payment models has become increasingly significant for value-based care (VBC) stakeholders, particularly with the introduction of CMS's mandatory Ambulatory Specialty Payment Model set to begin on January 1, 2027. This model mandates that outpatient specialists will be financially accountable for managing chronic conditions, aligning Medicare payments with clinician performance on quality and cost metrics. Concurrently, tensions are emerging surrounding the operational integration necessary for the successful transition to these value-based contracts, as highlighted by stakeholders emphasizing proactive care strategies amid financial pressures. These developments underscore the critical need for ACO leaders and health systems to adapt quickly to the shifting reimbursement landscape to ensure compliance and optimize financial performance.
Related Articles
BILLING AND CODING—SETTLEMENT AGREEMENTS: Aetna resolves Medicare billing allegations in $117.7 million settlement
BILLING AND CODING—SETTLEMENT AGREEMENTS: Aetna resolves Medicare billing allegations in $117.7 million settlement VitalLaw.com
Arizona cardiology group pays $4.75M to settle false claims allegations
Phoenix-based Tri-City Cardiology and three physicians have agreed to pay $4.75 million to resolve allegations they violated the False Claims Act by performing medically unnecessary vein ablations, th...
HHS Releases Medicare Fee-for-Service Improper Payment Rates for 2025
OIG green-lights ASC cataract supply discount proposal
HHS’ Office of the Inspector General issued a favorable result regarding a proposal to offer discounts to certain ASCs in intraocular lenses and supplies in cataract surgery, law firm Epstein Becker G...
Compliance for the Inpatient Psychiatric Facility (IPF-PPS): Minimizing Federal Audit Findings by Strengthening Best Practices
Compliance for the Inpatient Psychiatric Facility (IPF-PPS): Minimizing Federal Audit Findings by Strengthening Best Practices MedLearn Publishing
Attorney General Jeff Jackson Announces $12.7 Million Medicaid Fraud Sentencings - Office of Inspector General (.gov)
Attorney General Jeff Jackson Announces $12.7 Million Medicaid Fraud Sentencings Office of Inspector General (.gov)
10 Medicaid Providers Facing Fraud Charges - Office of Inspector General (.gov)
10 Medicaid Providers Facing Fraud Charges Office of Inspector General (.gov)
Arizona Cardiology Group to Pay $4.75M to Resolve Allegations of Unnecessary Vein Ablations - Office of Inspector General (.gov)
Arizona Cardiology Group to Pay $4.75M to Resolve Allegations of Unnecessary Vein Ablations Office of Inspector General (.gov)
ldyrda@beckershealthcare.com
From newsletter: ASCs' financial 'farm mentality' | Erlanger's Stark law cases advance | 4 DME fraud cases | ASC development site for surgeons debuts | Wis. system to close physician clinic ASC fi...
Final Rule: Revisions and Technical Corrections to 42 CFR Chapter V - Office of Inspector General (.gov)
Final Rule: Revisions and Technical Corrections to 42 CFR Chapter V Office of Inspector General (.gov)