TeamHealth hit with employer proposed class-actionMarch 22, 2022 06:41:51 PM
TeamHealth allegedly overbilled the Louisiana Municipal Risk Management Agency in nine out of 11 claims, according to the lawsuit.
Texas docs sue HHS over surprise billing ruleOctober 29, 2021 01:25:55 PM
The Texas Medical Association argues the surprise billing regulation unfairly favors insurers.
7 due diligence issues to avoid False Claims Act lawsuitsNovember 16, 2021 05:00:00 AM
As private equity companies snap up healthcare companies, they need to pop the hood to check for potential False Claims Act liabilities. Here are 7 due diligence areas to review.
3 obstacles University Hospitals overcame in adopting hospital at homeApril 14, 2022 12:00:00 PM
Dr. Peter Pronovost, chief clinical transformation officer at University Hospitals, on the challenges of rolling out remote patient monitoring technology and hospital-at-home programs during the pandemic.
Medical coding creates barriers to care for transgender patientsSeptember 13, 2022 11:41:42 AM
The codes used by U.S. medical providers to bill insurers haven't caught up to the needs of trans patients or even international standards.
Texas Medical Association files another surprise billing lawsuitSeptember 22, 2022 05:21:28 PM
The American Hospital Association and American Medical Association also hinted they may press their legal cases against the No Surprises Act.
Upcoding continues to inflate reimbursement, industry overseers sayOctober 06, 2021 04:26:54 PM
Massachusetts hospitals coded about 2 in 5 patients at the highest severity levels in 2020, up from about 1 in 4 patients in 2013.
Texas judge upends surprise billing law, for nowFebruary 24, 2022 04:58:21 PM
The federal judge ruled that some parts of the rule give too much power to insurers in the arbitration process and that HHS did not offer enough notice before it was implemented.
Surprise bill resolutions' path forward hinges on final ruleApril 20, 2022 04:30:54 PM
With the dispute resolution portal open, making further changes to the process could be difficult.
AHA, AMA sue over surprise billing arbitration processDecember 09, 2021 01:01:00 PM
The lawsuit challenges a narrow element of the rule implementing an arbitration process for out-of-network bills.
AHA, AMA drop surprise billing lawsuit, plan further legal actionSeptember 20, 2022 04:56:31 PM
The healthcare lobbying groups say the August final rule on surprise billing arbitration still poses concerns for providers.
Arbiters to expand surprise billing dispute resolution reviews, CMS saysApril 14, 2022 05:42:30 PM
CMS's revised guidance follows a court ruling against parts of the original regulation governing dispute resolutions.
Clash over MA coding intensity continues in rate notice commentsMarch 07, 2022 03:56:10 PM
Medicare Advantage associations supported CMS' use of the minimum coding adjustment, while MedPAC advocated for an increase.
More insurers cut payment for patient consultationsMarch 21, 2022 06:23:53 PM
The Centers for Medicare and Medicaid Services announced a change in how the codes should be used starting next year.
DOJ joins Cigna Medicare Advantage fraud caseAugust 25, 2022 03:48:34 PM
The insurer allegedly exaggerated the illnesses of its Medicare Advantage members to obtain higher payments from the federal government.
CMS finalizes 8.5% revenue bump projection for Medicare Advantage plansApril 04, 2022 04:41:35 PM
The final increase is larger than what CMS projected in its advance notice, which was already higher than experts expected.
5 things about DOJ's upcoding allegations against KaiserOctober 26, 2021 05:32:35 PM
Kaiser Permanente allegedly coerced employees to upcode claims for Medicare Advantage beneficiaries, resulting in an estimated 75% error rate, according to a new complaint from the Justice Department.
What Highmark's disclosure reveals about fraudulent billing claimsFebruary 08, 2022 04:00:35 PM
Pittsburgh's Highmark Health made the rare disclosure on Monday that it saved $245 million in 2021 by preventing instances of fraud, waste and abuse. The health insurer said its program has saved almost $1 billion since 2017.
Federal investigation into spine surgeries uses mob laws to target healthcare fraudFebruary 08, 2022 11:40:18 AM
Investigators allege a Texas company that arranges spine surgery and other medical care for people injured in car crashes accepted bribes in violation of 1960s-era racketeering law.
Florida providers, insurers won't use federal surprise billing resolution processJanuary 20, 2022 04:11:13 PM
Florida is among roughly a dozen states that CMS determined can use their own billing resolution rules in lieu of those under the federal No Surprises Act.
Providers push for changes to surprise billing resolution processDecember 07, 2021 03:06:11 PM
Insurers say the dispute resolution policy levels the playing field, but providers argue it tips the scales in favor of insurers.
Independent pharmacies in New York tussle with insurers over COVID-19 test paymentsOctober 19, 2021 03:32:00 PM
The New York association representing health plans said improper billing is partly to blame.
New model extends academic health care to more communitiesOctober 04, 2021 01:00:00 AM
With the opening of a unique outpatient care center in New Albany, Ohio, and more similar comprehensive care centers underway throughout central Ohio, The Ohio State University Wexner Medical Center is looking to change the future of outpatient care for all.
Post-pandemic, what's a phone call from your physician worth?December 08, 2021 09:10:01 AM
A four-digit "virtual check-in" billing code created during the pandemic, for phone conversations lasting just within that range has drawn outsize interest from physician groups.
Insurers to crack down on providers performing unscheduled proceduresAugust 09, 2022 05:09:17 PM
Horizon Blue Cross Blue Shield of New Jersey and Cigna recently announced they plan to heighten oversight of evaluation and management claims that include modifier 25.