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How Providers are Paid is Different from How Health Plans (Issuers) are Funded

How Providers are Paid is Different from How Health Plans (Issuers) are Funded

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...
Inefficacy is a 10 Letter Word for Nonsense

Inefficacy is a 10 Letter Word for Nonsense

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...
Errors Are Not Good in Baseball or in Claims Submissions

Errors Are Not Good in Baseball or in Claims Submissions

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...
Faxes & Snail Mail: Will Pandemic-Era Flaws Unleash Improved Health Technology?

Faxes & Snail Mail: Will Pandemic-Era Flaws Unleash Improved Health Technology?

by Erik Consorsha | 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...

Fraud Spotlight: Providers & The “Impossible Day”

by Erik Consorsha | 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...
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