It takes between 50 and 90 days after a claim is submitted for a medical practice to receive an insurance payment (excluding patient copays). Healthcare providers usually don’t receive the full amount they bill for and may receive as little […]

Hospital compliance programs have the potential to prevent costly denials and healthcare fraud investigations by conducting audits of high-risk areas, including coding, clinical documentation, and medical billing. Yet hospitals are still leaving millions of dollars on the exam room table. […]

Last week, the 11th Circuit (the federal appeals court for the Southeastern United States) issued a decision in the AsceraCare case.     We have been waiting for this decision since the case was argued two and a half years ago. […]

Physicians work hard to generate revenue, and with slim operating margins, they don’t want to contend with costly recoupments. Compliant coding and billing helps them avoid the focus of a pre- or post-payment audit. This article discusses four services that […]

The Centers for Disease Control and Prevention (CDC) is currently investigating vaping-related illnesses that have recently been reported. There are 450 confirmed or suspected cases in 33 states. The first death was reported on Aug. 23, 2019, in Illinois. The […]

It is estimated that as high as 80 percent of medical bills contain errors.1 As healthcare costs continue to rise, so too is the need for healthcare payers to reduce overspending resulting from avoidable billing errors and improper claims reimbursement.  […]

The Centers for Medicare & Medicaid Services (CMS) issued a final rule on September 5, 2019, intended to address program integrity and vulnerability issues. The Office of the Inspector General (OIG) testified before Congress in 2011 that fraud schemes relied […]

Using automated deep learning software, physicians without any background in computer programming were able to develop effective artificial intelligence technology for medical image diagnostic classification, a recent study found. As described in The Lancet Digital Health, scientists trained a deep […]

Expect more aggressive reviews of materials beyond the three-day criteria. Today I want to talk about skilled nursing facility, or as we often call them, “SNF” stays. For this, I’d like to start at the beginning. I’ll go all the […]

Santa Monica, Calif.-based Oceanside Medical Group failed to comply with Medicare requirements when billing for psychotherapy services, according to a report from HHS’ Office of Inspector General. The OIG said none of the 100 sampled beneficiary days, consisting of 103 […]

Hospitals have relied on a relatively manual process and retrospective audits for coding compliance, but new technology is streamlining the process, allowing providers to get ahead of denials. Healthcare technology is credited with advancing clinical care, allowing providers to detect […]

Pediatrics will see some important changes to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) that will take effect on Oct. 1. These include updates to both the tabular and the code set. Tabular updates An important clarification […]

The revolution in Blockchain technology has made its way to the healthcare industry and is already showing promising results in the technical advancements in health care. Healthcare Rallies For Blockchain, a study from IBM, found that 16% of surveyed healthcare executives have […]

The announcement is all but ensured to trouble providers already concerned about overreach. Federal healthcare oversight authorities have announced that they are expanding their “revocation and denial authorities” in an effort to enhance their efforts to fight waste, fraud, and […]

A look at the proposed Medicare Physician Fee Schedule. As you may be aware, the proposed Medicare Physician Fee Schedule (MPFS) rule for 2020 was officially published on Aug. 14, 2019.  There are many components to the rule, including a […]

A recent AMA study found that in 2018, for the first time, employed doctors outnumbered those that owned, or had an ownership stake in, a practice. For independent practices, this milestone highlights the importance of operating as efficiently as possible. […]

Poor healthcare IT infrastructure has contributed to patient care problems at Indian Health Service (IHS) hospitals, concluded a recent report by the HHS Office of Inspector General (OIG). The report found that the IHS had insufficient healthcare IT infrastructure to […]

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