In the first part of this series, we examined audit risks associated with observation claims. We should review what other risk areas providers might expect and why, as Recovery Audit Contractors (RACs) ramp up reviews again.

By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2, 2019. In the post, Verma asserted that CMS would require Recovery Audit Contractors (RACs) to “maintain a 95 percent accuracy score” and “an overturn rate of less than 10 percent.”

The American Medical Association is giving high marks to a proposal by the Centers for Medicare and Medicaid Services to reduce the burden of Evaluation and Management codes on physicians. E/M coding is the process by which physician-patient encounters are translated into five-digit...

One of the many issues that Congress can and should address to help improve this situation is to eliminate surprise medical billing once and for all. However, as it works to pass legislation on this issue, Congress must ensure that whatever solution it enacts does not lead to adverse, unintended consequences for patients or our health care system.

New proposals that prioritize patients over paperwork and let doctors be doctors by reducing administrative burdens—including simplifying coding for evaluation-and-management (E/M) office visit services—were released this week by the Centers for Medicare & Medicaid Services (CMS).