Claims Processing
St. Joseph Medical Center in Towson, Md., has agreed to pay $22 million to the federal government to settle allegations of violating the False Claims Act, Anti-Kickback Act and Stark Law, the Office of the Inspector General announced Tuesday. The federal investigation was triggered by physician whistleblowers.
The McKesson Corporation has secured deals with three of the four federally-approved Recovery Audit Contractors and will be providing medical necessity analytics tools for Medicare's auditing efforts in 43 states.
The 120 network hospitals and 30-plus physician groups participating in Blue Shield of California's claims transparency program continue to reap reduced claims cycle times and decreased denials, resulting in significant savings.
The Institute for Clinical Systems Improvement, a nonprofit organization comprised of 60 medical groups and six health plans in Minnesota and surrounding states, will use decision support technology to help ensure patients only receive medically appropriate diagnostic imaging tests.
In an effort to reduce the number of improper payments under state Medicaid plans, the Centers for Medicare & Medicaid Services has proposed new rules for Medicaid's Recovery Audit Contractor program.
During a recent exchange with sixteen national firms that offered a multi-stakeholder perspective, an interesting question surfaced: what is the “healthcare financial network”? Besides being characterized as critical infrastructure by Homeland Security, deemed the target of government reform in the Affordable Care Act and impacted by 5010 compliancy and ICD-10 transformation, well, what is it?
The Medagate Corporation, a provider of healthcare benefit services, has announced a partnership with pre-paid card and transaction processing company InComm to launch the OTCNetwork, a national over-the-counter benefits disbursement and redemption network for Medicare Advantage plan members.
Lest the healthcare industry not realize this simple fact: Although this does not garner much in the way of media attention, ICD-10 promises to improve the business of healthcare in numerous ways.
Healthcare reform is a hot topic at this years’ Medical Group Management Association Annual Conference in New Orleans. Everyone is playing the waiting game, but much speculation has been heard during educational sessions.
The growing number of self-pay patients is prompting one of the nation's largest healthcare coalitions to expand its revenue cycle management tools.