Virtual Benefits Administrator and Context4 Healthcare, Inc. announce real-time Medicare pricing automation

  • John Danza
  • Oct 04, 2017
  • Comments
vbalogo

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.

medicare, payment integrity, decisionpoint, UCR, Real-time solution, compliance,

EHR systems can’t protect you from the False Claims Act

  • John Danza
  • Aug 11, 2017
  • Comments
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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 ...

FWA, program integrity, EHR coding, payment integrity, Billing Integrity,

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,

Payers Use UCR Data to Drive Behavioral Health Outcomes

  • Margaret Klasa DC, APN BC
  • May 10, 2017
  • Comments
iStock-143175979

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.

population health, UCR, population management, behavioral health,

Payment Integrity and ACO Success

  • Margaret Klasa DC, APN BC
  • Apr 27, 2017
  • Comments
iStock-143175979

An ACO must show that the care given to the patient has achieved its quality measures.

Reference Based Pricing, ACO,

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