OIG Work Plan FY-2017 - Monitoring Claims for Potential Fraud

  • Cindy Gallee, JD, RHIA, CHC
  • Jan 25, 2017
  • Comments
Monitoring Claims for Fraud-canstockphoto25652629

The Office of Inspector General (OIG) Work Plan for Fiscal Year 2017 provides useful guidance for healthcare providers and payers to monitor their claims for potential fraud and quality of care concerns. The Work Plan (at https://oig.hhs.gov/reports-and-publications/workplan/) details areas where OIG will focus their review efforts by type of provider.

Fraud, Waste and Abuse, OIG,

Context 4 Healthcare, Inc. announces the latest addition to the Medicare pricing capability of the DecisionPoint Pricing System – Skilled Nursing Facility

  • John Danza
  • Dec 05, 2016
  • Comments
DecisionPoint Pricing System

Context 4 Healthcare, Inc., a leading provider of healthcare compliance and pricing solutions, announces today the implementation of the Skilled Nursing Facility Medicare Prospective Payment System (PPS) as the latest addition to Context’s DecisionPoint Pricing System™. This latest addition further expands the DecisionPoint Pricing System, the first solution in the healthcare industry to provide automated, real-time access to accurate Medicare fees for pricing healthcare claims duri ...

Pricing, Reference Based Pricing, Medicare Pricing,

New HCPCS Modifiers for 2017 Impact Reimbursement Rates

  • Margaret Klasa DC, APN BC
  • Dec 05, 2016
  • Comments
iStock_000009317132Small

The Centers for Medicare & Medicaid Services (CMS) has established 2 new HCPCS modifiers that will affect reimbursement rates for the year 2017. The first new HCPCS modifier is FX, which is X-ray taken using film. The Consolidated Appropriations Act of 2016 (Section 502(a)(1)) Medicare Payment Incentive for the Transition from Traditional X-Ray Imaging to Digital Radiography and Other Medicare Imaging Payment Provision amends the Social Security Act by reducing the payment amounts under th ...

Context 4 Healthcare, Inc. announces the latest addition to the Medicare pricing capability of the DecisionPoint Pricing System – End Stage Renal Disease

  • John Danza
  • Sep 12, 2016
  • Comments
130158907_75 (3)

Context 4 Healthcare, Inc . , a leading provider of healthcare compliance and pricing solutions, announces today the implementation of the End Stage Renal Disease Medicare Prospective Payment System (PPS) as the latest addition to Context’s DecisionPoint Pricing System™. The DecisionPoint Pricing System is the first solution in the healthcare industry to provide automated, real-time access to accurate Medicare fees for pricing healthcare claims during adjudication. When health plan ...

Pricing, Reference Based Pricing, Medicare Pricing,

ICD-10 Grace Period: The End is Near

  • Margaret Klasa DC, APN BC
  • Aug 05, 2016
  • Comments

On October 1, 2016, the joint initiative between the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA), also known as the “grace period” will come to an end. The one year “grace period” allowed unspecified ICD-10-CM codes to be submitted on Medicare Part-B physician claims. The grace period was created to help ease the transition from ICD-9 to ICD-10 coding systems for physicians. While Medicare required the correct level of ICD- ...

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