1. The DOJ is investigating Medicare Advantage Plans The Federal False Claims Act (FCA) is a law that prohibits knowingly submitting false claims for payment to government healthcare programs like
I’m increasingly seeing providers use codes for services that are not typically performed in acupuncture clinics. When questioned, the common response is: “I’m getting paid, so it must be okay.”
Can YOU supervise staff to provide acupressure or massage to patients? Yes, in some states you can, for example, in California, the Business and Professions Code permits acupuncturists to direct
Starting in 2025 we saw many changes to Medicare Advantage plans. In 2025 Premera BCBS exited the MA marketplace and BCBS of MA discontinued specific plans. This year BCBS of
Recently it was discovered that Aetna had been incorrectly processing claims for Suffolk County Employees insurance plan (EMHP). Apparently, this plan has a $30 max benefit, yet up until recently
The 2026 updates are mostly focused on making sure clinics have real, documented systems to protect patient information, (cybersecurity). Even solo-practitioners don’t fly under the radar as far as HIPAA
Understanding CPT 97110 is essential for accurate billing and proper reimbursement. This code describes therapeutic exercises provided with direct, one-on-one contact, designed to improve strength, endurance, range of motion, and
Some providers want to join insurance networks that are currently closed to new applicants. While nothing is guaranteed, the strategies below can increase your chances of getting noticed — and
1. Know What Kind of Audit You’re Dealing With Not all audits carry the same weight. Some have minimal consequences, while others can lead to clawbacks, expanded investigations, or serious
Many providers say they want to grow their practice — but few actually have a plan in place to make that happen. Or maybe you don’t want more patients, but
If you’ve recently received a “payment” from an insurance carrier like Vpay, Zelis, or QuicRemit, only to find it’s a Virtual Credit Card (VCC) —
If you’ve received letters, audits, or “re-priced” claims from any of these companies, you’re not alone. These third-party entities all play behind-the-scenes roles for major insurance carriers — and their
