Claims Processing
A pilot program being conducted by the Department of Veterans Affairs is testing whether using a private contractor to collect healthcare records from private physicians can speed the processing of veterans' disability compensation claims.
The owner of a Miami-area HIV clinic has been sentenced to almost six years in prison for his part in a Medicare fraud scheme.
The TriZetto Group has announced plans to enhance its care management and value-based solutions for health plan members and their providers through a strategic partnership with clinical analytics developer MEDai.
Hamilton Todd is a section manager with Mayo Clinic based out of its Jacksonville, Fla. location. Since retiring from the Navy in the early 1990s Todd has worked in revenue cycle management for Mayo serving all of its locations. In this month’s Q&A, Todd reflects on the state of medical banking in the industry as well as specific projects at Mayo Clinic.
A Midwest-based health plan administrator has signed on with Verisk Health to improve its offerings through the use of healthcare analytics.
The cost of healthcare under employer-sponsored health insurance climbed an estimated 6.3 percent for the year ending June 30, 2010, according to a new Thomson Reuters index.
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.