Posted and filed under Compliance, FWA, Healthcare, Payers.

Fraud Spotlight: Understanding Medicare as a Secondary Payer (MSP)

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes.  Recently, we discussed a situation where Medicare may still pay for a service, item or procedure…

Read the full article

Posted and filed under Compliance, FWA, Medical Record Auditing, Payers.

Fraud Spotlight: Document Now, Ace an Audit Later

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Every day, we read another article or another news release about the ever-changing…

Read the full article

Posted and filed under Fraud, FWA, Healthcare, Payers.

Fraud Spotlight: The Consequences of Relaxed Billing Regulations

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Although I had strongly thought about not discussing anything COVID-19 related in this…

Read the full article

Posted and filed under Healthcare, Payers.

HEDIS Season: The Home Stretch

As we approach the month of June, we also begin our downward slide towards the end of HEDIS season. HEDIS season, in all its glory, stretches through about 3 calendar seasons – and requires hard work from providers, chart reviewers, and record collection companies from December through October – depending on program enrollment, measures, and…

Read the full article

Posted and filed under Healthcare, ICD-10, Payers.

UnitedHealthcare & AMA Join Forces To Improve Healthcare Accessibility

UnitedHealthcare and the American Medical Association have partnered up to take the next step towards a patient-centric healthcare system. Earlier this month, the organizations announced their intent to propose a collection of 23 new ICD-10 codes associated with social determinants of health (SDoH). This collaboration is just one of many initiatives fronted by UnitedHealthcare and…

Read the full article

Posted and filed under Healthcare, Payers.

What is Maternalism in Healthcare?

The United States healthcare system is responsible for several crowning achievements, modern innovations, and…failures. Among those failures is the creation of helicopter patient care. You’ve heard about helicopter parenting, the overbearing, over-anxious, micromanagement of children – but we’ve been adopting a similar philosophy when it comes to patient care and patient communication. It might be…

Read the full article

Posted and filed under Coding, Payers.

We Need to Talk About Transgender Healthcare

Earlier this week, Advize Health partnered with Grassi Healthcare Advisors to host a webinar on transgender healthcare. This webinar sought out to educate the healthcare community not only on coding for transgender patients, but on every aspect of care for this critically underserved population, from claims denials to the cost of transitioning. The convergence of…

Read the full article

Posted and filed under Compliance, Payers.

Meet Your New MBI

If you’re covered by Medicare, or if your patients are covered by it – you’re about to start feeling more of the effects of The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Most organizations have been preparing for MACRA’s ripple effects for years, so this wave of change may just be another to…

Read the full article

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…

Read the full article

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…

Read the full article