A national coverage determination (NCD) [1] is a United States nationwide determination of whether Medicare will pay for an item or service. [2] It is a form of utilization management and …

Oct 16, 2025 · Private Medicare Advantage can include more types of coverage than traditional plans, but it doesn't necessarily deliver more or better care. Learn how to weigh the pros and …

The acronym HCPCS originally stood for HCFA Common Procedure Coding System, a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). Prior to 2001, …

Patient billing: A patient who is in on the scam provides his or her Medicare number in exchange for kickbacks. The provider bills Medicare for any reason and the patient is told to admit that …

Oct 9, 2025 · In 2021, the Centers for Medicare and Medicaid Services called upcoding “a serious problem” and the federal government periodically brings improper billing cases, both criminally …

Insurance policies often include specific guidelines regarding covered procedures and exclusions, and these rules can change annually. To avoid billing complications, the healthcare provider …

The Centers for Medicare and Medicaid Services (CMS), a component of the U.S. Department of Health and Human Services (HHS), administers Medicare, Medicaid, the Children's Health …

Balance billing, sometimes called surprise billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the …