by Advize Admin | Sep 30, 2022 | Compliance, FWA
Massachusetts has become the latest state to settle with health insurance giant Centene Corp. over allegations that it overbilled the state’s Medicaid program for pharmacy services, KHN has learned. Centene, the nation’s largest Medicaid managed-care insurer, will pay...
by Advize Admin | Aug 19, 2022 | Compliance, Healthcare
Kyle Kopec, Braden Health’s chief compliance officer, holds up a sample of diagnostic images left behind at a Tennessee hospital. As the company takes over abandoned hospitals, a major task is figuring out what to do with old medical records stacked in...
by Advize Admin | Jul 1, 2022 | Compliance, Events, Healthcare, Technology
Recently we presented to New York State Adult Day Services Association (NYSADSA) on this very topic. For those of you who do not know, NYSADSA is comprised of individuals, single-site programs, multiple-site programs, professional organizations, and supporters...
by Advize Admin | Mar 25, 2022 | Compliance
Providers are most often paid in Fee-For-Service (FFS) models for visits AFTER they occur. The patient sees a provider, a service or procedure is performed, and a bill (claim) goes to the health insurance plan (payor/issuer) for reimbursement for those services that...
by Advize Admin | Mar 11, 2022 | Compliance
Risk adjustment is a newer payment methodology that is designed to allow for a proactive approach to managing healthcare. It does not seek to audit against current claims or encounters. It is a yearly collection of diagnosis codes to accurately build a total RAF (Risk...
by Brian Boyce | Mar 4, 2022 | Compliance
Background Anyone who has taken the CRC™ (Certified Risk Adjustment Coder) curriculum can tell you that risk adjustment was first utilized in the mid-90’s for Medicaid purposes. The goal of risk adjustment has always been to collect data on patients so that money...
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