Claims Processing
A report from the California Nurses Association/National Nurses United charges that health insurers in California denied 26 percent of all claims submitted through the first nine months of 2010.
Patients hospitalized for major acute medical conditions - including heart attack, stroke and pneumonia - are less likely to die in high-spending hospitals, according to a new study in the Annals of Internal Medicine.
On February 2, 2011, the Centers for Medicare & Medicaid Services is publishing a final rule implementing provisions of the Affordable Care Act (ACA) that strengthen provider and supplier screening provisions under the Medicare, Medicaid, and Children's Health Insurance Program (CHIP).
Harvard Pilgrim Health Care and Tufts Health Plan have signed a memorandum of understanding to explore a merger of the two health plans.
New reimbursement models driven by healthcare reform top the list of healthcare provider predictions for 2011 from IDC Health Insights analysts Judy Hanover and Lynn Dunbrack.
The government's healthcare fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars for the Medicare, Medicaid and Children's Health Insurance Program in 2010, the largest sum ever recovered in a single year, according to findings published in the government's Health Care Fraud and Abuse Control Program report.
In an effort to be one of the first states to qualify for federal Medicaid EHR implementation incentive payments, the Texas Health and Human Services Commission has contracted with the CGI Group for its turnkey Medicaid Electronic Health Record solution.
The Medicare Payment Advisory Commission voted last week to recommend to Congress a 1 percent increase in Medicare hospital inpatient and hospital outpatient prospective payment system rates for 2012, in addition to a 1 percent pay rate increase for physicians.
A New Orleans-area doctor and the owner and operator of a medical equipment company have been sentenced to prison on charges of healthcare fraud involving durable medical equipment, according to the departments of Justice and Health and Human Services.
Orlando's Florida Hospital, billed as the largest and busiest hospital in the United States, has entered into an agreement with ERIS Medical Technologies to implement that company's automated .net charge capture software.