Pyramids Global -
Medical Billing & RCM Insights Blog

As states push for Medicaid work requirements, healthcare providers face new billing complexities. States like Arkansas and Ohio aim to enforce work, study, or volunteer mandates for benefit retention, risking coverage loss for non-compliance. Pyramids Global steps in to simplify this chaos. They ensure compliance by staying updated on state-specific rules, defending documentation during audits, correcting coverage errors swiftly, and keeping patients informed. By partnering with Pyramids Global, providers can focus on care while minimizing financial disruptions from policy changes.

Big news for heart care: Medicare now covers transcatheter tricuspid valve replacement (TTVR) but only under strict CMS conditions. Hospitals must use FDA-approved TTVR for severe tricuspid regurgitation, form specialized heart teams, and enroll patients in CMS-backed studies tracking outcomes for 24 months. Compliance errors can lead to denied claims and lost revenue. Pyramids Global steps in with compliance checks, heart team coordination, documentation support, and audit prep, transforming regulatory challenges into streamlined workflows. Stay focused on innovation while Pyramids Global handles the billing maze.

CMS is making big changes to Medicare. On March 12, the agency announced it’s shutting down four payment models by 2025—Maryland Total Cost of Care, Primary Care First, End-Stage Renal Disease Treatment Choices, and Making Care Primary. The reason? They failed to cut costs, improve quality, or streamline operations. CMS wants to refocus on prevention, patient empowerment, and competition. Additionally, two proposed programs—the Medicare $2 Drug List and Accelerating Clinical Evidence—were scrapped after a January executive order eliminated legal backing for them.