Claims Processing
A Mississippi health system and three hospitals in Texas, Indiana and Alabama are illustrating how hospitals can thrive in a tough economic environment. The facilities recently won awards for their leadership in initiatives to improve financial sustainability and achieve significant financial performance improvements.
With patients paying more out-of-pocket costs and exchanges increasing the number of plans providers deal with, having financial counselors in a practice may become a necessity.
Medicare announced Friday that it was revising rules intended to prevent the agency from paying twice for the same prescriptions for seniors receiving hospice care. The drug categories in question were identified in a 2012 investigation by the HHS inspector general.
If your modus operandi is to appeal all denied claims, you may want to reconsider because some claims are not worth it.
Of the states that built their own health insurance exchanges that are now operational, Washington, Kentucky and Minnesota enjoyed some successes that might be replicated.
The American Hospital Association is asking federal Medicare leaders to stem the practice of using sample hospital audit data to extrapolate overpayments eligible for recovery. The lack of clarity regarding standards for short patient stays has clouded the issue.
A group of chiropractors went to war with the Blues and it seems they've won, successfully using a novel legal theory that now has lawyers setting their sights on other large insurers.
For the second year in a row, Humana ranked first in overall performance among 148 payers, according to the 2014 PayerView Report. The report ranks health insurers according to specific measures of financial, administrative and transactional performance.
The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled, sowing animosity between health systems and the feds.
A new interpretation of a 40-year-old law could offer healthcare providers more options for appealing payer recoupments or preventing them altogether.