Healthicity Blog

Few coding modifiers have drawn as much scrutiny as modifier -25. Used to indicate a significant, separately identifiable evaluation and management (E/M) service on the same day as another procedure, modifier -25 has long been a point of focus for third-party payors and government enforcement...

Healthcare compliance incidents can emerge at any time, like an anonymous report of an over payment, suspicious ePHI access alert, or a whistleblower allegation of suspected fraud. For compliance teams, managing these incidents quickly, accurately, and within federal and other regulations is...

With the launch of the CMS TEAM Model, nearly 1,000 hospitals across the U.S. are entering a new era of accountability, care coordination, and financial risk. For the first time in recent history, CMS is mandating that selected hospitals take full responsibility for the cost, quality, and outcomes...

A strong compliance program doesn’t happen by accident: it starts with a solid foundation of education. But not just any training will do. The most impactful programs go beyond checking the box. They deliver relevant, engaging content that’s designed with your people and their roles in mind.

Uncover blind spots for hospitals and discover how Healthicity’s Audit Manager+ can help

The OIG added many items to its work plan in July 2025. Below we have summarized a few of these items most likely to affect health care provider organizations.

Today’s compliance teams face rising expectations, tighter regulations, and mounting complexity. Yet many are still relying on static spreadsheets and siloed tools that can’t keep up with their day-to-day needs.

An eye care organization in Pennsylvania recently agreed to pay $790,000 to resolve allegations of submitting improper Evaluation & Management (E&M) claims alongside bilateral eye injections. The violations, which occurred between 2018 and 2025, involved billing for same-day services in a way that...