OIG Work Plan Priorities Affecting Independent Practice Billing
Federal audits are targeting six specific billing patterns in independent practices right now.
Priya Subramaniam
Staff Writer, Denial & Appeals
Priya Subramaniam
Priya Subramaniam holds an MHA from the University of Minnesota and worked as a denial management specialist at a multispecialty group practice for five years before moving into trade journalism. She writes data-driven breakdowns of payer denial patterns and coaches readers through the appeals process through case-study reporting.
12 stories
RAC Audit Target Areas for Physician Practices in 2024 and 2025
Practices can review CMS's published RAC audit targets quarterly to reduce exposure.
Priya Subramaniam
CMS and OIG Regulatory Guidance on AI Use in Claims Submission
Medicare regulators now require AI billing tools to account for individual patient circumstances.
Priya Subramaniam
Payer AI in Claims Adjudication and Prepayment Audit Expansion
Insurers are using AI to deny claims faster and earlier, before practices can respond or appeal.
Priya Subramaniam
Gold Carding Programs by State and Payer Adoption Rates
Texas's gold card program has qualified only 3 percent of physicians despite high approval rates.
Priya Subramaniam
PAHPA and Federal Prior Authorization Legislation Status in Congress
Two stalled congressional fights threaten public health and patient care access.
Priya Subramaniam
Emerging Denial Categories in Behavioral Health Billing
Payer AI is tightening documentation rules and creating new denial categories in behavioral health.
Priya Subramaniam
Medical Necessity Denial Trends and Payer Clinical Criteria Divergence
Payers apply their own clinical criteria, not CMS standards, driving divergent denial rates.
Priya Subramaniam
Prior Authorization Denial Trends Across Major Commercial Payers
Data shows payers deny prior authorizations at wildly different rates under identical rules.
Priya Subramaniam
Real-Time Prior Authorization Standards and FHIR API Payer Readiness
Practices must separate the 2026 and 2027 deadlines to avoid costly compliance mistakes.
Priya Subramaniam
Prior Authorization Burden Data and Physician Practice Time Costs
Physicians spend 13 hours weekly on prior authorizations, with denial rates varying wildly by payer.
Priya Subramaniam
CMS Physician Fee Schedule Changes and Practice Revenue Projections
CMS cuts procedural RVUs while exempting E&M, reshaping specialty revenue.
Priya Subramaniam