ICD-10 And Cost Of Care Transparency Among Leading Issues For Physicians In 2015

ICD-10 And Cost Of Care Transparency Among Leading Issues For Physicians In 2015

Tuesday, September 15, 2015

Did you know that the migration to ICD-10 and the cost of care transparency are among the leading issues for physicians in 2015? The ICD-10 migration will see the diagnosis codes grow from about 18,000 numeric codes to over 140,000 alphanumeric codes. While it will provide greater granularity in terms of disease management, it will likely cause significant disruption and billing issues in the short-term....

Read more
Why Is There So Much Unnecessary Care?

Why Is There So Much Unnecessary Care?

Tuesday, September 15, 2015

Did you know that Walmart is receiving unexpected benefits from its leading edge program for medical "centers of excellence"? Walmart is sending employees to chosen "centers of excellence", and is finding that 30% of the transplants initially recommended are not necessary.Read More

Read more
9 New York Doctors Are Accused of Defrauding Medicaid Using Homeless People

9 New York Doctors Are Accused of Defrauding Medicaid Using Homeless People

Tuesday, September 15, 2015

Did you know that 9 New York doctors are indicted in March 2015 on Medicaid fraud using homeless people as patients? The doctors offered free shoes as an inducement to be subjected to a raft of unnecessary medical tests and equipment prescriptions. These tests led to $7 million in false Medicare and Medicaid billings between 2012 and 2014. ...

Read more
What Is A Medical Loss Ratio? The Check Will Be In The Mail

What Is A Medical Loss Ratio? The Check Will Be In The Mail

Tuesday, September 15, 2015

Did you know that Medical Loss Ratio is arguably the single most important financial measure in the healthcare world? For an insurance company, it represents how much of the annual premiums goes toward medical expenses versus marketing, administration and insurance company profit. It is now legislatively limited to 20% on small company plans and 15% on large company plans....

Read more
Blue Cross finds angioplasty payments vary widely by market

Blue Cross finds angioplasty payments vary widely by market

Tuesday, September 15, 2015

Did you know that the median amount that a Blue Cross insurer paid for an angioplasty in Los Angeles was between $10,749 and $67,937, a 532% difference and the most extreme variation in the report? In Chicago, Blue Cross reimbursed providers between $15,951 and $49,604 for the same types of angioplasties, a 211% difference. There were 39 metropolitan areas in which angioplasty payments varied by at least 100%. ...

Read more
list of healthcare providers that have been banned from participation in Medicare, Medicaid

list of healthcare providers that have been banned from participation in Medicare, Medicaid

Tuesday, September 15, 2015

Did you know that the Office of Inspector General (OIG) publishes a list of over 125,000 healthcare providers that have been banned from participation in Medicare, Medicaid, etc.? Exclusions are based on conviction of program-related crimes, healthcare fraud, patient neglect/abuse, controlled substance conviction and more. Read More

Read more
Recovery auditing in Medicare for fiscal year 2013

Recovery auditing in Medicare for fiscal year 2013

Tuesday, September 15, 2015

Did you know that the Center for Medicare & Medicaid Services (CMS) enlists the help of outside Recovery Audit Contractors (RAC’s) to identify and correct improper payments that have occurred? For FY2013, this resulted in the correction of over 1.5 million underpayments and overpayments, and returned in excess of $3.0 billion to the Medicare Trust Fund....

Read more
Comprehensive Error Rate Testing

Comprehensive Error Rate Testing

Tuesday, September 15, 2015

Did you know that Medicare’s improper payment rate is calculated annually via the Comprehensive Error Rate Testing (CERT) program? Each year, CERT evaluates a statistically valid random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules. For the twelve months ending June 30, 2013, the overall error rate was 12.7% amounting to $45.8 billion in improper payments. This is up significantly from the prior year rate of 10.1%....

Read more
The $272 billion swindle

The $272 billion swindle

Tuesday, September 15, 2015

Did you know that certain areas of the country are a “hotbed” of fraudulent medical billing, including such places as Miami, New York City, Detroit, Houston, Los Angeles, Tampa, and Baton Rouge? Organized crime in these regions systematically target & exploit control weaknesses in healthcare reimbursement systems, particularly Medicare....

Read more
Doctors make millions off of Medicare

Doctors make millions off of Medicare

Tuesday, September 15, 2015

Did you know that the Center for Medicare & Medicaid Services (CMS) released data in April showing the summary of payments made by Medicare to 880,000 physicians nationwide? This data has been used to identify providers with patterns of suspect or even potentially fraudulent billing. One ophthalmologist from West Palm Beach, FL collected nearly $21 million, while a cardiologist in Ocala, FL received $18 million in 2012. Seven doctors pulled in excess of $10 million....

Read more