Claims Processing

Enrollment in managed Medicaid plans is on the rise, according to Mark Farrah Associates, a Kennebunk, Me.-based data aggregator and publisher of health plan market data.

There are many steps that inpatient hospital providers can take to avoid denial of their claims when submitting Medicare fee-for- service claims.

Two owners of a seven-location chain of mental health clinics have pled guilty in Miami District Court for their roles in a scheme that resulted in the submission of more than $200 million in fraudulent Medicare claims.

After two decades of critical nurse and physician shortages, an economic climate of high unemployment would seem to be the antidote for the healthcare sector.

Employers with self-funded health plans have a common enemy: The emergency room.

Using a credit card scanner in a hospital is great for buying flowers from the gift shop or lunch in the cafeteria, but it isn’t as easy when used to pay bills.

The community pharmacy may be an enduring and endearing image of rural America, offering everything from prescription medications to milk to sunglasses, but its ability to handle the complex needs of a residential home or senior housing complex leaves something to be desired.

In the current healthcare environment, hospitals need to capture every dollar from their payers, and as quickly as possible.

Those keeping watch over the Centers for Medicare and Medicaid Services’ Recovery Audit Contractor (RAC) program say the audits haven’t been as bad as was originally feared.

Hospitals are falling short of the Joint Commission's language access requirements for patients with limited English, according to a new report.