DEAR DR. ROACH: When I have appointments with my physicians (at our local, highly rated academic health system), they no longer do a physical exam. But in the after-visit note, there is a documented ...

We’ve been accused of upcoding our therapy reimbursement claims. What can we do? “Upcoding” — billing for services under procedure codes that are reimbursed at higher rates than those applying to ...

We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...

Andrew S. Oseran, MD, MBA, MSc, hypothesizes that higher Medicare Advantage (MA) risk scores may result from either a more accurate capture of beneficiaries' comorbidities or inappropriate "upcoding" ...

We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...

Despite criticisms over inaction, the HHS is aware of the flurry of fraud in the Medicare Advantage program that’s costing the government billions of dollars a year, and is thinking about how to curb ...

ANAHEIM, CA—Most interventional cardiologists believe that public reporting of PCI outcomes leads to avoidance of procedures and upcoding of patient clinical comorbidities, according to a survey of ...

The Alliance for Quality Nursing Home Care and American Health Care Association expressed outrage over a news report that alleged widespread use of so-called “upcoding” in nursing homes. “This article ...

High-intensity billing during "treat and release" emergency department stays rose significantly from 2006 to 2019, and was partially fueled by factors such as changes in case mix and service offering ...