Context4 Healthcare, Inc. will showcase its FirstPass™ claim editing solution as an exhibitor at the 2015 PLEXIS CONNECT Users Conference taking place September 20 - 23 in Ashland, OR. Context’s FirstPass™ claim editing solution is pre-integrated with the PLEXIS QC™ Quantum Choice system within the adjudication process. Using the FirstPass™ real-time web services capability, FirstPass™ edits each claim almost instantly and returns the results to Quantum Choic ...

The results from The Workgroup for Electronic Data Interchange ( WEDI ) 2015 ICD-10 Industry Readiness Survey are in. WEDI surveyed payers, providers, and vendors and has identified that only about 20 percent of physician practices surveyed have started or completed external testing and less than 50 percent responded that they were ready or would be ready for Oct. 1, 2015. “The survey results are based on responses from 621 respondents, consisting of 453 providers, 72 vendors and 96 heal ...

Polysomnography services, or sleep studies, are prone to errors in billing and need to be carefully monitored by payers. Sleep study billing is significantly mentioned as an audit topic in the OIG Work Plan for 2015 and using this plan, a recent OIG report 1 found deficiencies in the payment of sleep study services by a Medicare Administrative Contractor. At issue in this report were duplicate billing of sleep study services and inadequate provider documentation. A sleep study is ...

Detecting fraud, waste and abuse has become more important than ever with the U.S. Department of Health and Human Services Office of Inspector General (OIG) recently announcing a new legal team dedicated to the enforcement effort. This team will enforce OIG industry guidance by affirmatively litigating against providers who commit fraud through the use of civil monetary penalties and exclusion from federal health care programs. According to Lisa Re, the Chief of the Civil Remedies ...

Context 4 Healthcare, Inc . , a leading provider of healthcare compliance and reimbursement solutions, and AXA Assistance USA, the world leader in providing assistance, announce today the successful implementation of Context’s FirstPass™ claim editing solution within AXA’s benefit claim management workflow. The implementation included Context’s DecisionPoint™ UCR fee schedule integrated with FirstPass™ to provide unprecedented real-time access to usual, custo ...