Virtual Benefits Administrator and Context4 Healthcare, Inc. announce real-time Medicare pricing automation
Available to VBA subscribers today, this solution provides real-time Medicare Prospective Payment System (PPS) pricing during claims processing. Direct PPS pricing ensures compliance with the Centers for Medicare and Medicaid Services (CMS). It eliminates complexity and the need to utilize less accurate substitutes like RBRVS.
EHR systems can’t protect you from the False Claims Act
The recent Department of Justice (DOJ) $155 million False Claims Act settlement with eClinicalWorks highlights a problem that has existed in the EHR software industry for a long time. Any EHR system that attests to do everything for the integrated health system can’t possibly provide the highest possible level of all aspects of functionality. Some parts of the system will be concentrated upon while others will get just enough attention so the vendor can say they have the ...
Medicare Advantage Plans Under the FWA Microscope
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” ...
Payers Use UCR Data to Drive Behavioral Health Outcomes
Context's UCR data can help with Behavioral Health population health management. Behavioral Health issues compound the chronic condition scenario. The United States spends more on mental health and addiction than on any other medical condition including heart disease, trauma, and cancer.
Payment Integrity and ACO Success
An ACO must show that the care given to the patient has achieved its quality measures.