Posted and filed under Business, Payers.

Aetna Faces Uphill Battle

If you haven’t heard the name Dr. Jay Ken Iinuma before, you’re about to get acquainted. Iinuma is the former Medical Director of health insurance giant Aetna, and he might just be the reason yet another Aetna deal flatlines. During a recent deposition in a lawsuit between Aetna and Gillen Washington, a young adult with…

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Posted and filed under Community, Payers.

Is HHS About to Lose Funding?

Yesterday, President Donald Trump presented his $4.4 trillion FY19 budget proposal – and it looks like the Department of Health and Human Services (HHS) is going to have to tighten its fiscal belt. Trump’s proposed budget demonstrates a 21% decrease from HHS’ 2017 budget. That means the agency may be facing a cut as steep…

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Posted and filed under Compliance, Healthcare, Payers.

The Road to Compliance

The road to compliance is long and bumpy, but a trip we must all take in 2018. In January 2017, compliance professionals from the Department of Health and Human Services (HHS), Office of Inspector General (OIG) held an assembly in which they discussed how to measure the efficacy of Compliance Programs. From this roundtable came…

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Posted and filed under Healthcare, Payers.

Is This The End of CHIP?

The Children’s Health Insurance Program (CHIP) is a program that has managed to gain (mostly) bipartisan support, as it provides low-cost healthcare to children in families that earn too much money to qualify for Medicaid; but its days may be numbered.  The funding for CHIP ended on September 30th, 2017…and unfortunately, Congress has not yet…

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Posted and filed under Compliance, Healthcare, Payers.

HHS Retracts Support For Financial Assistance Charity

In an unexpected, albeit responsible move, Health and Human Services has retracted their support for a Patient Assistance Program. The Caring Voice Coalition (CVC) is a patient assistance charity that provides financial support to Medicare beneficiaries and other patients. Found in 2003 with seemingly noble intentions, the CVC was founded in 2003 to support patients…

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Posted and filed under Coding, Medical Record Auditing, Payers.

Mammography Coding

In honor of Breast Cancer Awareness Month, we’ve decided to release a brief reminder to not only schedule a routine mammogram, but to recall the 2017 Mammogram Coding Changes. Mammography Coding The Centers for Medicare and Medicaid Services (CMS) announced in November 2016’s final rule that they would not be able to accommodate the new…

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Posted and filed under Coding, Medical Record Auditing, Payers.

Think Twice Before Appending Modifiers

Coding Modifiers In the English language, a modifier is used to describe the who, what, how, why, and/or where of a situation. Coding modifiers perform the same role for medical coders and billers. These types of modifiers further describe procedure codes without altering its original definition. Modifiers can be found in both the CPT and…

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Posted and filed under Business, Healthcare, Payers.

Value-Based Purchasing Still Perplexing Providers

Providers are still struggling to align with payers in the transition to value-based purchasing. Value-based purchasing is used to measure, report, and reward excellence in health care delivery. To properly incentivize high-quality care, value-based purchasing requires the cooperation of employer purchasers, public sector purchasers, health plans, and providers who are all tasked with assessing care…

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Posted and filed under Medical Record Auditing, Payers.

The Claims Denial Epidemic

The American Hospital Association recently released the results of a survey conducted to explore the efficacy of the RAC program in hospitals nationwide. The survey utilized the results responses submitted by 676 participating hospitals in order to explore the program’s impact in the second quarter of the year 2016. The results suggest that while Medicare…

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Posted and filed under Healthcare, Payers.

Payers Push for Stronger Prescription Cost Control

Over the years, healthcare costs have continued to skyrocket for consumers and providers alike. It is a well-known fact that the United States spends considerably more on healthcare costs than any other country in the world.  In fact, the United States spends 50 percent more than the next-highest spender-which is about $9,086 per U.S. citizen….

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