As providers keep hearing over and over-from RACs and their own Medicare contractors, insufficient documentation is frequently the reason for claim denials. Whether these denials come up front from ...

The Centers for Medicare & Medicaid Services (CMS) uses coverage determinations to decide how Medicare should cover treatments, services, and items. These rules usually apply nationwide. The CMS ...

In 2026, the Centers for Medicare and Medicaid Services (CMS) will expand prior authorization in the fee-for-service program through the Wasteful and Inappropriate Service Reduction (WISeR) Model.

Inconsistent Medicare Part B local coverage determinations (LCDs) create disparities in Medicare beneficiary access to items and services, a recent OIG report concludes. The OIG focused on LCDs issued ...

The Centers for Medicare & Medicaid Services (CMS) uses national coverage determinations to determine how it should cover all treatments, services, and items. The CMS makes national coverage ...

Organogenesis (ORGO) and MiMedx (MDXG) traded lower on Friday after the Centers for Medicare & Medicaid Services (CMS) announced the withdrawal of final Local Coverage Determinations (LCDs) related to ...

Starting October 1st, 2025, patients will have access through streamlined coverage criteria that mirrors Medicare's established local coverage determinations and Evicore’s recently updated guidelines.

The U.S. Centers for Medicare & Medicaid Services announced that several Medicare administrative contractors have formally withdrawn local coverage determinations for skin substitutes. There are ...