payments
publication date
Payer
MA Star Ratings: A Path to Dominance or Billions in Losses?
The answer is both as payers benefit unevenly from CMS' fine turning.
Payer
Medicare Overpaid $22.5M for Incorrect Place-of-Service Codes
The Office of Inspector General (OIG) uncovered overpayments in 2019 and 2020 for care provided to Medicare beneficiaries.
Revenue Cycle
GI Docs Rail Against UHC's Looming Prior Authorization Mandate
GI docs say the payer is using AI to move large volumes of services through prior authorization.
Revenue Cycle
Are Commercial Payers to Blame for Majority of Rev Cycle Claim Denials, Payment Delays?
One study says yes.
Revenue Cycle
Medical Groups Voice Concern Over Payer's New Coding Policy
More than 100 medical associations have taken issue with a new policy from Cigna regarding claims coded with modifier -25.
Revenue Cycle
The Useful 5: Regulatory Roundup for Rev Cycle Leaders
HealthLeaders' regulatory round up series highlights five essential governing updates that cover every aspect of the revenue cycle that leaders...
Revenue Cycle
Medicare Paid Providers $128M in Duplicate Payments for VA Care
Auditors blame CMS for failing to establish a data-sharing agreement with the VA.
Revenue Cycle
A $3.3B Payment Increase or $115M Cut in 2024? Where Will Your Organization Land?
Health equity and payment updates take center stage in CMS' fiscal year 2024 IPPS proposed rule.
Payer
Bill Introduced to Combat Medicare Advantage Upcoding
The legislation aims to reduce overpayments to Medicare Advantage (MA) plans.
Payer
Medicare Advantage has Lower Utilization, Higher Clinical Care Quality
Performance was higher in Medicare Advantage (MA) health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Payer
Covenant Healthcare Paid $69M to Settle FCA Allegations
Two physicians allegedly involved in the scheme to defraud Medicare, Medicare, TRICARE and other government payers will also pay a...
Finance
The Exec: CFO Kevin Murphy on the 'Fundamental Flaw' in Fee-For-Service Payments
'The fee-for-service model does not create a competitive dynamic in the fees that are charged broadly across the healthcare system,'...