Skip to main content

Claims Processing

By Kelsey Brimmer | 11:51 am | January 10, 2013
While only 17 percent of the working age U.S. population, adults with disabilities account for disproportionately high (almost 40 percent) emergency department visits, according to a recent study from National Institutes of Health (NIH) researchers.
By Frank Irving | 03:06 pm | January 04, 2013
The American Taxpayer Relief Act of 2012 became law on Jan. 2. Among its many provisions, the law postpones a scheduled 26.5 percent payment cut for physicians and other practitioners who treat Medicare patients, but payments to physicians may be temporarily held.
By Kelsey Brimmer | 11:46 am | January 03, 2013
With the implementation of the Affordable Care Act (ACA) over the next few years there are going to be several new fees for both health insurers and employers sponsoring self-insured health plans that go into effect.
By Kelsey Brimmer | 11:48 am | December 14, 2012
Bundled payment and payment reform in general are hot topics in healthcare circles, and will prove to be a challenge for many. Jay Sultan, thought leader for payment reform at TriZetto, a healthcare management solutions company, shared with Healthcare Finance News five key ideas for hospital leaders to consider in order to break barriers to successfully implement payment reform at their organizations.
By Kelsey Brimmer | 10:43 am | December 12, 2012
Consumer-directed health plans with high deductibles typically exempt recommended preventive care such as annual physicals or screening tests from the plan's deductible or require only a small copay as a way to ease financial barriers and encourage patients to seek care. However, many patients don't understand their plan benefits for preventative office care and tend to avoid visits altogether.
By Kelsey Brimmer | 10:47 am | December 04, 2012
Last week New York Attorney General Eric T. Schneiderman announced a $3.1 million settlement with Excellus BlueCross BlueShield requiring the insurer to refund 12,000 plan members who overpaid their healthcare providers as a result of the company's improper accounting of deductibles.
By Kelsey Brimmer | 03:14 pm | November 28, 2012
BayCare Health System in Clearwater, Fla., has agreed to pay over $10.1 million to the federal government to resolve allegations that the health system violated the False Claims Act announced the U.S. Justice Department (DOJ) last week.
By Kelsey Brimmer | 03:12 pm | November 20, 2012
In an effort to control costs and get people covered by health insurance, the Affordable Care Act offers a number of options for covering low-income people. Among those options is the Basic Health Program, which some say will save money and others say will kill health insurance exchanges.
By Kelsey Brimmer | 10:49 am | November 20, 2012
The U.S. Department of Health and Human Services (HHS) will need to place a lot of emphasis on implementing the Affordable Care Act (ACA) in the coming year, according to the Office of Inspector General's (OIG) annual summary of management and performance challenges facing the agency, released this week.
By Kelsey Brimmer | 10:55 am | November 19, 2012
A recent New England Journal of Medicine (NEJM) study points to a new pilot program that offers payment models that may encourage hospitals to better coordinate transitions of care, resulting in fewer readmissions.