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Find news and solutions for healthcare payers and providers. Recognize and avoid potential fraud, waste, and abuse scenarios. Real-time clinical claim editing are analyzed to maximize provider reimbursements.

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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
helloquence-61189-unsplash

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,

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 ...

DecisionPoint Pricing System, Reference Based Pricing, Medicare Pricing,

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
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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 ...

DecisionPoint Pricing System, Reference Based Pricing, Medicare Pricing,

Finding Healthcare Fraud in ICD-10 Using ICD-9 Investigation Schemas

  • John Danza
  • Jul 08, 2016
  • Comments
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An ongoing concern within every payer’s special investigation unit (SIU) has been how to adapt existing investigations and future analytics to ICD-10 codes. The thought of having to recreate years of investigative knowledgeware is daunting enough, but the thought of having to figure out the ICD-10 equivalents of the ICD-9 based knowledgeware make it feel akin to climbing Mount Everest. But those ICD-10 codes are hiding out and getting exploited, so something must be done. Con ...

FWA, Potential Fraud Scenarios,

Context Goes to Washington as Exhibitor at 35th Annual SIIA Conference

  • John Danza
  • Oct 14, 2015
  • Comments
Context_to_Exhibit_at_35th_Annual_SIIA_Conference

Conference attendees will have the chance to learn about a new product this year - just recently, Context introduced a new Inpatient UCR module as part of its DecisionPoint™ Health Payment System. With the increasingly high cost of inpatient services, many valued UCR customers have been looking for a way to benchmark inpatient facility claims. As the trusted source for UCR fee data (including Medical, HCPCS, Anesthesia, Dental and Outpatient), Context has developed an independent source for inpatient charges for more than 740 Diagnosis-Related Groups (DRGs).

FWA, Payers,

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