Experts in healthcare reimbursement and regulation,
providing customized consulting
and education services.

Training Programs

We bring the experts to you with a range of on-site education options and bootcamp style programs that teach how a firm grasp of the rules leads to operational excellence.

More information »

Audits & Assessments

Our team of specialized regulatory specialists can assist your organization in revving up your revenue cycle by auditing and assessing key processes for coding and billing.

More information »

Regulatory Monitoring

Our team is available for ongoing regulatory watchdog services that answer your questions and offer you the latest Medicare news, analysis and operational guidance.

More information »

Archive for insurance

Jul
08

Number of uninsured increases by 700,000 in 2008

Posted by: Case Management Weekly | Comments (0)
Email This Post Print This Post

Based on the Centers for Disease Control and Prevention’s (CDC) National Health Interview Survey, 43.8 million Americans did not have health insurance in 2008. That’s 700,000 more people than in 2007 and 2.8 million more than 1997.

The amount of children under 18 that were uninsured in 2008 remained the same as in 2007 at 8.9%, and was down from 1997 at 13.9%.

Massachusetts had the lowest rate of uninsured persons (3%), and Texas had the highest (22.9%).

Source: Centers for Disease Control and Prevention

Categories : Managed care
Comments (0)
Jul
08

Healthcare fraud effects public and private insurance alike

Posted by: Compliance Monitor | Comments (0)
Email This Post Print This Post
A report published by the George Washington University Medical Center, Health Insurance Fraud: An Overview, states that the healthcare fraud problem is not specific to public insurers (i.e., Medicare and Medicaid). According to the report’s authors, Sara Rosenbaum, Nancy Lopez, and Scott Stifler, private insurance providers are just as susceptible to fraud as Medicare and Medicaid.
 
The report states, “What is absolutely clear from virtually every reliable source on the subject is that healthcare fraud is a systemic problem affecting public and private insurers alike, in the individual market, the employer-sponsored group market, and public programs.”
 
The report also states that medical providers commit 80% of healthcare fraud, consumers commit 10%, and a combination of insurers and their employees commit the final 10%.
 
The report’s authors argue the reason Medicare and Medicaid appear to be more susceptible to fraud and abuse is because those programs cover the elderly, women, minorities, the less educated, and the poor, who are also the most vulnerable to fraud.
Categories : Managed care, Medicaid
Comments (0)
Mar
25

Tip: Discounts to uninsured or underinsured patients

Posted by: Compliance Monitor | Comments (0)
Email This Post Print This Post
Hospitals may discount services to uninsured and underinsured patients who are unable to pay their hospital bills. According to OIG guidance for providing discounts, hospitals:
  • Should reflect full uniform charges on the Medicare cost report and inform the Medicare administrative contractor that it has reported its full charges
  • Can forgo collection efforts aimed at a Medicare patient if the hospital documents the patient is indigent or medically indigent
  • May claim discounted amounts as Medicare bad debt after determining that no source other than the patient is legally responsible for the unpaid deductible and coinsurance.
  • Can determine their own indigent-care criteria if they uniformly apply it to Medicare and non-Medicare patients
This tip was adapted from the Compliance Program Effectiveness Handbook. For more information on how to order your copy, visit the HCMarketplace.
Feb
25

Study shows rise in federal healthcare spending

Posted by: Patient Access Weekly Advisor | Comments (0)
Email This Post Print This Post
A federal study shows that government healthcare spending is expected to increase to $1.191 trillion this year as the recession suppresses private healthcare spending, the Wall Street Journal reports.
 
The country’s healthcare costs are projected to reach $2.510 trillion overall, a 5.5% increase from 2008, according to the study by economists and actuaries at CMS published this week in Health Affairs.
 
To read the full story, click here.
Categories : Managed care
Comments (0)
Jan
26

Growing need for Medicaid strains states

Email This Post Print This Post

Medicaid enrollments are surging in some states because workers are losing their health insurance along with their jobs, The New York Times reported January 22.

Some states saw surges between 5% and 10% in the last 12 months. Growth rates doubled from the prior year in some states.

Read the full story in The New York Times.

Categories : Medicaid, e-Newsletters
Comments (0)
Jan
23

Obama to ease restraints on SCHIP

Posted by: Patient Access Weekly Advisor | Comments (0)
Email This Post Print This Post

Within days of taking office, President Barack Obama plans to rescind a Bush administration policy that has impeded state efforts to provide health insurance to children from low- and middle-income families through the State Children’s Health Insurance Program (SCHIP), aides and advisers announced. The policy is one of many that the new administration hopes to change or withdraw in its first weeks in office.

Obama has said, for example, that he objects to a Bush administration rule that grants sweeping new protections to health workers who refuse to provide care because of their “religious beliefs or moral convictions.”

Read the full story in The New York Times.

Categories : e-Newsletters
Comments (0)
Jan
15

Massachusetts governor weighs insurance hearing

Posted by: Patient Access Weekly Advisor | Comments (0)
Email This Post Print This Post

Massachusetts Gov. Deval Patrick has asked the state’s most prominent hospital and health insurance leaders to take quick action to hold down rapidly rising healthcare costs, suggesting that if they did not take steps on their own, they might face new government regulation, according to the Boston Globe.

Patrick said he is considering holding hearings on health insurance premiums and the primary driver of premium increases—the rates hospitals charge insurers for members’ medical care. He has also said the state Division of Insurance has the power to reject rates it deems excessive.

Read the full story in the Boston Globe.