A new legislative proposal was submitted to the U.S. Senate Finance Committee and the Centers for Medicare & Medicaid Services by the American Medical Association to reform the current Merit-based Incentive Payment System (MIPS) and transition to a redesigned program called the Data-Driven [...]

States and professional organizations are increasingly challenging private insurers' downcoding of evaluation and management (E/M) services, a practice clinicians say undermines physician judgment and delays appropriate reimbursement. E/M downcoding occurs when payers automatically reduce the level of a clinician-reported E/M code, resulting in [...]

The American Academy of Sleep Medicine recently sent a letter to UnitedHealthcare, raising concerns about the use of Synapse Health for durable medical equipment (DME) fulfillment for CPAP therapy. The letter outlined member‑reported issues affecting patient access to care and clinical workflows. AASM [...]

The American Academy of Sleep Medicine recently sent a letter to Wellmark to raise concerns about a payer policy affecting reimbursement for in-lab diagnostic and titration sleep studies. The policy restricts reimbursement for Current Procedural Terminology (CPT) codes 95810 (diagnostic polysomnography) and 95811 (polysomnography with PAP titration) when [...]