Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
More articles — Page 16
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SNF Consolidated Billing: Which Services Belong on the Facility Claim
Medicare's SNF consolidated billing rule bundles nearly every service into the facility's claim, and outside suppliers that bill P…
Skilled Nursing Facility Medical Review: The Skilled Need Question
Medicare's skilled-need test, not patient improvement, decides whether a Part A stay survives medical review under the Jimmo maint…
Skin Substitutes in Nursing Home Residents: Audit Exposure
Skin substitute claims for nursing home residents can violate Medicare's SNF consolidated billing rule before medical necessity is…
Skin Substitute LCDs: Where the Coverage Rules Stand
CMS withdrew the 2026 skin substitute LCDs in December 2025, but the $127.14 per sq cm payment rule and the new audit exposure it…
Nursing Home Administrator License Investigations
A facility survey deficiency and a state board license complaint are separate proceedings, but one record can open both against an…
False Claims Act Exposure in Remote Patient Monitoring
Remote patient monitoring billing exposure turns on the civil False Claims Act's knowing and materiality standards, not on an ordi…
UPIC Audits of Skilled Nursing Facilities
UPICs review SNF consolidated billing and PDPM coding, and a small sample of flagged claims can be extrapolated into a demand many…
UPIC Audits of Remote Patient Monitoring Practices
How UPICs select RPM claims for review, what an additional documentation request covers, extrapolation risk, and the appeal path a…
RPM in Assisted Living and Senior Living Facilities
Assisted living and senior living residents live in a non-skilled setting with different billing, consent and enrollment rules for…