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OIG Raises Concerns About Service and Payment Denials Under Medicare Advantage Plans According to CMS, almost 37% of all Medicare beneficiaries will enroll in Medicare Advantage plans in 2019. In addition, the market remains very attractive to insurers who plan to...
Over the last few years, there has been a trend toward automating the medical necessity UR screening process using software to extract clinical data and either apply commercial criteria or create an acuity score. As I have strolled across trade show floors, I see...
In 2013, the Centers for Medicare and Medicaid Services (CMS) finalized the “Two-Midnight” Rule addressing when beneficiary hospitalizations are appropriate for inpatient payment under Medicare Part A. CMS adopted the “Two-Midnight” Rule to simplify the beneficiary...
In 2016, the Office of the Inspector General (OIG) published a report, “Vulnerabilities Remain Under Medicare’s 2-Midnight Policy”, summarizing the first findings of hospital billing patterns since the implementation of the Two-Midnight Rule. The results surprised...
OIG Raises Concerns About Service and Payment Denials Under Medicare Advantage Plans According to CMS, almost 37% of all Medicare beneficiaries will enroll in Medicare Advantage plans in 2019. In addition, the market remains very attractive to insurers who plan to...
Over the last few years, there has been a trend toward automating the medical necessity UR screening process using software to extract clinical data and either apply commercial criteria or create an acuity score. As I have strolled across trade show floors, I see...
In 2013, the Centers for Medicare and Medicaid Services (CMS) finalized the “Two-Midnight” Rule addressing when beneficiary hospitalizations are appropriate for inpatient payment under Medicare Part A. CMS adopted the “Two-Midnight” Rule to simplify the beneficiary...
In 2016, the Office of the Inspector General (OIG) published a report, “Vulnerabilities Remain Under Medicare’s 2-Midnight Policy”, summarizing the first findings of hospital billing patterns since the implementation of the Two-Midnight Rule. The results surprised...
From Defense to Offense: Strengthen Your Denials Management Strategy December 3, 2025, 11:00 AM PSTDenials are on the rise, but not all denials are created equal. With mounting payer obstacles, regulatory complexity and staffing constraints, hospitals need smarter...
Level the Playing Field: How Payers Keep Denial Rates High, and What to Do About itMore than 25 years ago, on a day like any other, when Dr. Jerilyn Morrissey (now Chief Medical Officer at CorroHealth) was just a new physician and documentation was a pen-to-paper...
WISeR (Wasteful and Inappropriate Service Reduction) Model November 2025 Overview CMS has the responsibility to protect the Medicare Trust Funds, and routinely analyzes data associated with all facets of the Medicare program. A 2020 analysis of claims submitted by...
