Posts

Showing posts with the label Payer Audit Defense and Compliance

What Is the CY2026 Efficiency Adjustment and How Does It Impact Internal Medicine Billing?

Image
The CY2026 Efficiency Adjustment is one of the important changes introduced under the 2026 Medicare Physician Fee Schedule. Effective January 1, 2026, CMS finalized a 2.5% reduction to the work RVUs of most non-time-based services . However, the adjustment does not apply broadly to every service billed by an internal medicine practice. Time-based services, including many evaluation and management (E/M) and care management services, are excluded. For internal medicine practices, understanding which services are affected is important because the adjustment can change reimbursement for certain procedures and ancillary services even when claims continue to process normally. For a detailed overview, practices can review What Is the CY2026 Efficiency Adjustment and How Does It Impact Internal Medicine Billing? . What Is the CY2026 Efficiency Adjustment? CMS finalized the efficiency adjustment as part of the CY2026 Physician Fee Schedule. The policy applies a -2.5% adjustment to the work comp...

Payer Audit Defense and Compliance: A Complete, Proactive Framework for Healthcare Organizations

Image
Payer audit defense and compliance have become critical priorities for healthcare organizations operating in today’s tightly regulated environment. As payers intensify scrutiny to control costs, providers face increasing audits that can disrupt cash flow, strain staff, and expose organizations to financial penalties. Without a structured payer audit defense strategy, even compliant providers can suffer revenue losses. This comprehensive guide explains how healthcare organizations can strengthen payer audit defense and compliance programs while maintaining operational efficiency. It also highlights how medical billers and coders  help providers reduce audit risk and administrative burden. Understanding Payer Audit Defense and Compliance in U.S. Healthcare Payer audit defense and compliance refer to the systems, processes, and controls healthcare organizations use to prepare for, respond to, and prevent payer audits. These audits assess whether billed services meet coverage, coding,...