Medicare, Medicaid & Private Payor Updates

Responding to Medicare Audits of PCR Testing for UTIs in 2026 - Liles Parker

Responding to Medicare Audits of PCR Testing for UTIs in 2026

Medicare, Medicaid & Private Payor Updates /

(December 18, 2025): Laboratory Polymerase Chain Reaction (PCR) testing for urinary tract infections (UTIs) offers rapid, sensitive pathogen detection but often presents complex coding and billing challenges for Medicare providers and laboratories. Medicare contractors are increasingly denying UTI test claims due to issues with medical necessity, documentation, and improper coding/billing practices. Robust compliance and up-to-date […]

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Wound care aukdit and skin substitute audit 2026 - Featured Image - Liles Parker

Responding to Wound Care Audits and Skin Substitute Audits in 2026

Medicare, Medicaid & Private Payor Updates, Other /

(December 11, 2025): In 1789, when commenting on the newly established U.S. Constitution, Benjamin Franklin famously wrote to French scientist Jean-Baptiste Le Roy that “In this World, Nothing Can be Said to be Certain, Except for Death and Taxes.” [1] In view of the last thirty years of persistent, repeated Medicare audits and investigations, we

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Prior Authorization Audits for Certain ASC Services in 2026 - Featured Image - Liles Parker

Prior Authorization Demonstration Audits for Certain ASC Services Start in January 2026

Medicare, Medicaid & Private Payor Updates /

(December 09, 2025): The Government Accountability Office (GAO) has long expressed concerns regarding the fraud, waste and abuse risks inherent in the Medicare program. In fact, GAO first designated Medicare as a “High Risk” program due to its size, complexity and susceptibility to improper payments.[1] Throughout 2025, Medicare providers and suppliers were subjected to significant

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Wasteful and Inappropriate Service Reduction (WISeR) Model - Liles Parker

Overview of the WISeR Model: How Should Your Practice Respond?

Medicare, Medicaid & Private Payor Updates /

(September 25, 2025): Medicare providers and beneficiaries will likely face a number of new challenges over the next five years. As you will recall, the Centers for Medicare and Medicaid Services (CMS) Innovation Center has set a goal of having 100% of Traditional Medicare (also commonly referred to as “Original Medicare”) beneficiaries move over to

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Ketamine Audits and Investigations are on the Rise - Featured Image

Ketamine Audits and Investigations are on the Rise! Are Your Ketamine Infusion / Injection Practices Compliant with the Law?

Medicare, Medicaid & Private Payor Updates /

(October 10, 2024): Ketamine has been in the news again lately. . . for all the wrong reasons. In August 2024, Federal prosecutors out of the Central District of California announced the indictment of five individuals, including two physicians, who allegedly played a role in the fatal ketamine overdose of Matthew Perry in October 2023.

Ketamine Audits and Investigations are on the Rise! Are Your Ketamine Infusion / Injection Practices Compliant with the Law? Read More »

Amniotic Membrane - Featured Image - Liles Parker

Navigating Amniotic Tissue / Amniotic Membrane / Skin Substitute Audits and Investigations

Medicare, Medicaid & Private Payor Updates, Other /

(August 14, 2024): For almost a century, health care providers have used amniotic tissues / amniotic membranes in the care and treatment of wounds.[1] In recent years, health care providers have greatly expanded the scope of therapeutic applications employing amniotic tissues / amniotic membranes in wound care procedures. These developments have led to increased scrutiny

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Health Care Provider Risks of Chelation Therapy - Liles Parker

Health Care Provider Risks When Ordering and Billing Chelation Therapy Services

Medicare, Medicaid & Private Payor Updates /

(January 25, 2024): Although chelation therapy[1] has played an important role in mainstream medicine for many years,[2] it is still considered by many clinicians and regulators to fall within the category of “Complementary and Alternative Medicine.” Proponents of chelation therapy in alternative medicine practices have supported its use in treating Alzheimer’s disease,[3] Parkinson’s disease, multiple

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Texas HHSC-OIG is Ramping-Up its Investigations of Medicaid Pediatric Telemedicine Claims

Medicare, Medicaid & Private Payor Updates /

(June 27, 2023): In the State of Texas, Medicaid plays a significant role in providing healthcare services to a large portion of the population. With more than 5.9 million[1] Texans (approximately 18.9% of the current population[2]) enrolled in Medicaid, it is an essential program for qualifying low-income citizens. In Texas, Medicaid costs taxpayers over $40

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COVID-19 Vaccine Mandate Update

Medicare, Medicaid & Private Payor Updates /

(June 20, 2023): In response to the recent public health crises, the Centers for Medicare & Medicaid Services (CMS) first implemented a vaccine mandate for healthcare providers in late 2021. This policy was an effort to safeguard the vulnerable populations served by healthcare workers. This directive required that all healthcare workers, volunteers and third-party contractors

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HHS Departmental Appeals Board (DAB) Appeals

Medicare, Medicaid & Private Payor Updates /

(June 15, 2023): The Department of Health and Human Services (HHS) is enormous, employing more than 80,000 individuals[1] who work in a dozen operating divisions and an even greater number of independent offices that report directly to the Office of the Secretary.[2] One of these independent offices is the HHS Departmental Appeals Board (DAB or

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