Payment Integrity & Fraud Prevention
Expert articles and analysis related to payment integrity & fraud prevention.
AI Summary — Last 24 Hours
In the last 24 hours, the conversation around value-based care (VBC) and payment integrity has intensified, particularly following a recent opinion piece in The Boston Globe advocating for a payment model that incentivizes doctors to prioritize patient health outcomes. This approach aligns with CMS’s ongoing efforts under the Trump administration to enhance VBC frameworks, emphasizing accountability and quality in care delivery. Additionally, CMS has started discussions about addressing billing practices related to nitrous oxide administration during labor and delivery, indicating a shift toward clarifying reimbursement policies that could significantly impact ACOs and care delivery transformation efforts. This is crucial as it directly affects providers' financial strategies and patient care models. For further insights, see the Boston Globe opinion and the RAC Monitor.
Related Articles
A look at how Optum Rx is using AI to address pharmacy fraud, waste and abuse
A look at how Optum Rx is using AI to address pharmacy fraud, waste and abuse Fierce Healthcare
STAT+: The intersection of ‘Apprentice’ and the No Surprises Act
A STAT investigation explores how a new company is profiting from the arbitration process in the No Surprises Act.
Assessing Duplicative Federal Benefit Programs and Preventing Abuse
Assessing Duplicative Federal Benefit Programs and Preventing Abuse American Enterprise Institute - AEI
Laboratory Question for the Week of March 23, 2026
Why were PLA codes 0285U and 0365U revised in 2026?
Respiratory Question for the Week of March 23, 2026
Can we bill for the administration of nitrous oxide during labor and delivery or for other minor procedures performed at bedside?
Proliance Surgeons to pay $4.45M to settle ransomware class-action lawsuit
Seattle-based Proliance Surgeons has agreed to a $4.45 million settlement to resolve class action litigation stemming from a February 2023 data breach that affected more than 437,000 patients, the HIP...
The Hidden Cost of Provider Coding
The Hidden Cost of Provider Coding AAPC
Understanding value-based payment models in health care
Understanding value-based payment models in health care Aledade
Former Northeast Kingdom Human Services employee sues agency over alleged Medicaid fraud
Former Northeast Kingdom Human Services employee sues agency over alleged Medicaid fraud VTDigger
What Revenue Cycle, CDI, and Denials Teams Need to Know About the Data Payers Receive: Part I
EDITOR’S NOTE: The author of this article used artificial intelligence (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional judgme...