Congressional Opposition to WISeR Model Demands Performance Data From CMS
A congressional coalition sent a letter on June 22 to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, M.D., expressing...
Recent legislation in Florida now requires patient overpayments to be refunded within 30 days of identification, joining Minnesota in enforcing stricter timelines around patient credits. While these laws currently apply to a handful of states, they signal a broader shift toward heightened regulatory scrutiny nationwide. This could bring an increased risk of audits, penalties, and reputational exposure for organizations unprepared.
For laboratories, compliance is no longer just about knowing state-specific requirements; it’s about adopting best practices that stand up anywhere. Proactively monitoring credit balances, clearly documenting when credits are identified, and issuing timely patient refunds are becoming essential components of a defensible revenue cycle strategy.
Technology plays a critical role in this process. Having clear visibility into when a credit was created, when it was reviewed, and when it was confirmed as a true patient credit allows organizations to manage timelines with confidence and demonstrate compliance when questions arise. As regulatory expectations continue to evolve, disciplined credit management will separate reactive organizations from those truly prepared.
- Sarah Stewart, Vice President, RCS
A congressional coalition sent a letter on June 22 to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, M.D., expressing...
July marks the final month of the 2026 PAMA reporting period. Laboratories that meet the definition of an applicable laboratory, which most do, have...
Effective July 1, 2026, Humana will charge a $5.00 administrative fee for Medicare Advantage paper claim submissions.