Medical Billing News

Group Calls for Off-Label Drug Claims Reimbursement Guide

August 29, 2016 - The federal government should develop a single resource that clarifies what off-label drug uses would qualify for federally-funded claims reimbursement, researchers stated in a recent study in the Journal of the American Medical Association. CMS currently uses five approved compendia to make federal payment decisions regarding the use of off-label...


Articles

Pharma Payments Influence Prescription Drug Spending

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Payments from pharmaceutical manufacturers may be more influential on physician prescribing habits than concerns over the rise in prescription drug spending, according to a recent study in the...

Strong Compliance Programs Key to Avoiding Healthcare Fraud

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Preventing and catching healthcare fraud schemes has recently jumped to the forefront of many public and private payer programs that are designed to reduce unnecessary healthcare spending. The...

OIG: NY Hospital Received $14.2M in Medicare Improper Payments

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A New York-based hospital overbilled Medicare by over $14.2 million between 2011 and 2012 because it did not have appropriate medical billing measures to prevent and identify improper payments, reported...

4 Medical Billing Issues Affecting Healthcare Revenue Cycle

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Medical billing is the backbone of healthcare revenue cycle management, but many providers experience significant challenges with efficiently and accurately billing patients and payers for services they...

31% of Providers Still Use Manual Claims Denial Management

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As the transition to value-based care carries on, many healthcare providers are reexamining their current healthcare revenue cycles to account for new alternative payment models. With providers...

HHS, DoJ Announce Largest Healthcare Fraud Takedown

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The Department of Health and Human Services (HHS) has recently partnered with the Department of Justice (DoJ) to charge 301 individuals, including 61 physicians and licensed medical professionals, with...

OIG: Provider-Based Status Leads to Improper Medical Billing

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The Centers for Medicare and Medicaid Services (CMS) could reduce improper medical billing by eliminating provider-based designations or equalizing payments for the same services provided at different...

74% of Providers See Increased Patient Financial Responsibility

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A recent report from InstaMed found that 74 percent of healthcare providers reported an increase in patient financial responsibility in 2015, which has prompted healthcare revenue cycle management...

Turnkey Approach to Fighting Healthcare Fraud, Waste, Abuse

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Healthcare fraud, waste, and abuse (FWA) investigators have a tough job. Keeping pace with the latest schemes, continuously weeding through hundreds of false-positive leads, and understanding the right...

8 Tips for Avoiding Denials, Improving Claims Reimbursement

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If your practice is like most, your billing staff sees the words “CLAIM DENIED” fairly often, which not only leads to frustration and increased work but also reduced revenue for the practice...

Patient Billing Challenges Revenue Cycle Management

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Patient payment and billing are significant revenue cycle management challenges that should not be ignored.  According to a recent survey conducted by Navicure, 63 percent of participants recognized...

HHS Challenges Industry to Improve Medical Billing Process

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It’s no secret that the current medical billing process is deeply flawed. To face this issue, the Department of Health and Human Services (HHS) recently announced the “A Bill You Can...

71% of Healthcare Execs Anticipate Revenue Cycle Growth in 2016

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Healthcare revenue cycle managers are likely to have their hands full through the rest of 2016 as the industry sees increases in revenue, patient volume, and opportunities for mergers and acquisitions,...

Aetna Awarded $37.4 Million in Healthcare Fraud Lawsuit

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Aetna was awarded $37.4 million in a lawsuit against Bay Area Surgical Management and a group of surgical centers, which allegedly conducted various types of healthcare fraud, including overbilling and...

BMC Pays $1.1M to Resolve Medical Billing Fraud Allegations

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Medical billing fraud, waste and abuse in Medicare and Medicaid appears to be an incurable disease. Although funds for these services are supposed to be for vulnerable populations with health needs, they...

Top 5 Ways to Optimize Healthcare Revenue Cycle Management

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Revenue cycle management remains relatively elusive in the new healthcare landscape, as new regulations and reforms have led the industry to evolve and left many hospitals scrambling to keep their...

How to Retool Patient Collection Procedures to Boost Revenue

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Days in A/R and cost to collect have always been challenging metrics for healthcare organizations to manage; however, today’s payment environment brings additional difficulties. The average annual...

Using Big Data in the Hunt for Healthcare Fraud, Waste, and Abuse

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When the novel The Hunt for Red October was first published, it did more than elevate Tom Clancy from obscure real estate agent to international best-selling author. It also introduced readers to the...

April Sees an Influx of New Medicare Fraud Charges

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Healthcare fraud continues to extracts a huge toll on Medicare as well as the entire US healthcare system. In many cases, providers take advantage of both the healthcare system and the patients they are...