Claims Processing
CMS will analyze enrollment and medical claims to keep bad actors out of Medicare, share information with Medicaid and thwart fraudulent payment.
HMS Holdings Corp. announced Monday that it will acquire HealthDataInsights, the Medicare recovery audit contractor for Region D, for approximately $400 million.
Nearly half of healthcare providers plan to replace their current revenue cycle management (RCM) system in the next five years, according to a new survey from market researcher KLAS.
Prescription drugs are more expensive in the United States than in any other developed nation. What are some of the reasons behind the astronomical cost of pharmaceuticals, and are there any steps the government could take to make drugs cheaper to US buyers? Check out this interesting graphic and give us your opinion.
The deadline for HIPAA 5010 compliance is knocking at the door but there is confusion, even at this late date, about what "readiness" means, says the Healthcare Billing & Management Association (HBMA).
The Bethesda Healthcare System, a not-for-profit, two-hospital system in Boynton Beach, Fla., intends to redesign its revenue cycle processes, adding a fully automated financial and clinical patient record.
The National Association of Insurance Commissioners has adopted model language for health insurance exchanges designed to provide guidance to individual states as they establish insurance exchanges as required under health reform.
The Centers for Medicare & Medicaid Services will soon be outfitted with new state-of-the-art fraud fighting analytic tools to prevent wasteful and fraudulent payments in Medicare, Medicaid and the Children's Health Insurance Program.
The Department of Veterans Affairs has announced it will begin using Medicare's standard payment rates for certain medical procedures performed by non-VA providers on Feb. 16, 2011.
In a new sample audit of Medicaid payments, the Office of the Inspector General found the government "inappropriately paid" 6.5 million claims for a total of $724 million. The claims were for personal care service provided by attendants who didn't have proof of federally required qualifications.