Keeping a watchful eye on telehealth claims

  • Cindy Gallee, JD, RHIA, CHC
  • Jun 05, 2018
  • Comments

Telemedicine has grown significantly in recent years due to new technologies and consumer demand. According to an April 2017 study by Grand View Research, the telemedicine market is expected to grow to $113.1 billion by 2025 with an estimated compound annual growth rate (CAGR) of 18.8%. An anticipated 7 million patients in the U.S. will access telemedicine services in 2018, a sharp increase from 350,000 in 2013. Payer reimbursement policies, on the other hand, are slow to adapt to the new services.

FWA, Fraud, Waste and Abuse, Payers, healthcare, payment integrity, SIU, Fraud Prevention, Fraud Schemes,

Medicare Advantage Plans Under the FWA Microscope

  • Margaret Klasa DC, APN BC
  • Jun 29, 2017
  • Comments

HEALTHCARE  is again the most popular topic for the past few weeks.  Even friends that don’t know much about the industry have asked: what’s going on with Medicare?  Apparently, recent allegations of high dollar medical fraud have raised concerns about Medicare Advantage Plans and Payment Integrity.  One law firm pointed out that this is just the start.  “DOJ’s big settlement — $16.7 million for risk adjustment “upcoding” ...

FWA, Waste and Abuse, Fraud, healthcare, payment integrity,

RAC Ramp Up for 2017

  • Margaret Klasa DC, APN BC
  • Feb 27, 2017
  • Comments

The five regional Recovery Audit Contractors (RACs) are ramping up their automated and complex reviews starting this month. The Centers for Medicare & Medicaid (CMS) Medicare Fee for Service (FFS) audit program awarded contracts in October 31, 2016 ....

healthcare, rac audit, healthcare compliance, program integrity, CMS audit, medicare, medicaid, FFS, FFS audit,

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