by Advize Admin | Nov 11, 2022 | Healthcare
Doris Spatz takes a once-a-day pill, Kisqali, to keep her metastatic breast cancer in check. As a patient in the Defense Department health system, she can fill routine prescriptions at a military pharmacy without a copay but also has the option of using a regular...
by Advize Admin | Jul 1, 2022 | Healthcare
Consumers, employers, and just about everyone else interested in health care prices will soon get an unprecedented look at what insurers pay for care, perhaps helping answer a question that has long dogged those who buy insurance: Are we getting the best deal we can?...
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 25, 2022 | Healthcare Facepalm, OIG Files
I recently needed to get a CT scan done as part of a full physical examination. The ordering doctor and the imaging center are associated with a very large group in the Central Florida area. Upon leaving the visit with the physician, I was handed a hard...
by Advize Admin | Feb 25, 2022 | Healthcare
The Comprehensive Error Rate Testing (CERT) program is a CMS initiative that seeks to identify national error rates in a variety of areas. Temporarily suspended due to COVID-19, the CERT program came back into action in August 2020. The program, in a...
by Advize Admin | Feb 4, 2022 | Healthcare Facepalm
Jamie Taylor received two letters from the Missouri Department of Social Services Family Support Division that began, “Good news,” before stating that she was denied Medicaid coverage. Her income exceeded the state’s limits for the federal-state public health...
by Advize Admin | Nov 12, 2020 | Coding, Fraud, FWA
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...
by Advize Admin | Dec 27, 2016 | Coding, Compliance, Healthcare
If you’re in the healthcare industry – you’ve heard about MACRA. The Medicare Access and CHIP Authorization Act, Medicare’s two-track payment system for physicians and healthcare providers will be implemented on January 1st, 2017. Understanding the new system and...
by Advize Admin | Apr 26, 2016 | Coding, FWA, Payers
Billing issues, to an extent, are expected in any physician or healthcare provider office. Most patients are in possession of both medical and vision benefits coverage, and this duality often causes confusion in ophthalmology offices. Certain procedures that are...
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