The payer will expand its partnership with Allina Health to cover more members under Medicare Advantage value-based contracts. “This value-based agreement for Humana Medicare Advantage members is an important part of helping our members achieve their best health,” Chuck Dow, vice president and Medicare regional president for Minnesota at Humana. “We’re excited to share with […]
Zero-paid claims are defined as any claims submitted by healthcare providers that are not paid. The problem is that when performing statistical extrapolations, auditors (ZPICs, or Zone Program Integrity Contractors, and others) routinely screen out zero-paid items when they extract the claims from a sample. This is a violation of at least 12 parts of […]
Hospitals across the nation are seeing lower profits, and it’s all because of a sudden tsunami of Medicare and Medicaid provider audits. Whether it be by Recovery Audit Contractor (RACs), Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), or otherwise, hospital audits are rampant. Billing errors, especially “supposed bundling,” are causing a high rate […]
Kaufman Hall predicts hospital operating margins will fall 80% below pre-pandemic levels by the end of 2021. Projecting cash flow always has been a challenge, but now that hospitals are operating on extremely tight margins, access to accurate projections is critical. On a related note, research from Market cube and Waystar found that fewer than […]
In its simplest form, revenue cycle management is the process healthcare providers use to ask for, track, and collect revenue for services rendered to patients. But as medical billing gets more complex, revenue cycle management is expanding beyond the business office. At Jackson Hospital in Montgomery, Alabama, for example, revenue cycle management also includes health […]
Surprise billing occurs when patients receive care from out-of-network providers without their knowledge. On July 1, the Biden Administration passed an interim final rule: the first portion of the “Requirements Related to the Surprise Billing Act,” in an attempt to curb excessive costs patients are required to pay in relation to surprise billing. The rule […]
Omnichannel strategies are becoming increasingly significant to successful member engagement. What is omnichannel engagement? Omnichannel engagement is a strategy that originated as a sales and marketing term but has infiltrated various sectors of the healthcare industry with the rise of healthcare consumerism. This strategy involves using various consumer touchpoints to push a product in a […]
Revenue is not a goal; it is an outcome. Healthcare providers, hospitals and other services, have struggled for the last decade to maintain sustainable revenue for survival. This has been exacerbated by the pandemic changing borderline net revenue to worsening losses. Many have instituted new practices to acquire more revenue not realizing increased revenue is […]
As promised, this is a follow-up to our first blog post on the new federal transparency requirements. In our prior post, we summarized the Hospital Price Transparency rule which went into effect on January 1, 2021, and here we discuss the transparency rules contained in the Consolidated Appropriations Act, 2021 (the “Act”), which apply to both health plans […]
CMS recommends that organizations review the agency’s most recent guidance on telehealth billing. CMS is reminding providers to ensure that Medicare claims for telehealth are correctly billed. The agency issued broadly expanded telehealth services as part of its response to the COVID-19 public health emergency. However, a 2018 Office of Inspector General audit found that CMS paid […]