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Insights That Move Healthcare

Expert perspectives on revenue cycle, risk adjustment, compliance, and healthcare strategy – designed to help providers, plans, and leaders make smarter operational and financial decisions.

Modifier 59: Why $4.4 Million in Podiatry Bil...

Podiatry billing services for foot and ankle surgery require a level of modifier precision that standard automated billing systems are not built to deliver – and the consequences of getting it wrong are measurable. OIG's December 2025 audit of podiatrists' Medicare claims found that 49 of 100 sampled claims did not comply with Medicare requirements, projecting approximately $4.4 million in improper payments across the full claim population [1].

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Podiatry coding review for Modifier 59 and XS documentation accuracy in multi-procedure foot and ankle surgery claims
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DME Billing
December 12, 2024

Urinary Catheter Fraud Is Impacting A...

If your billing department handles durable medical equipment (DME), you should stay tuned in to the actions of the Cente...

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Market-based logistics efficiency
September 19, 2023

Home Health Billing Fraud Study Sheds...

Providers who outsource home health billing see multiple benefits, but one of the most important is access to a tool in ...

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Market-based logistics efficiency
September 12, 2023

Changed Your Service Lines? It's Time...

In the wake of COVID, budget crunches, and labor shortages, many hospitals and health systems have been making the smart...

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Risk Adjustment Coding Strategy
June 15, 2021

Home Health Billing Impact: Home Infu...

Medical billing has seen multiple changes because of the COVID-19 pandemic. We’ve covered the Hospital at Home and its p...

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