Upcoding Crackdown: Federal Efforts Fail to Benefit Private Insurers

For more than a decade, taxpayer-funded health care programs have seen a steady uptick in higher-paying billing codes. Office visits, outpatient services, and emergency room care have all been billed at progressively higher reimbursement codes, raising fees by billions of dollars. Many providers contend the shift is the result of sicker patients coupled with the

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Mutual Trust Key to Claims Advocacy Success

Psychosocial issues pose the biggest barrier to successful claim outcomes, according to Rising’s 2016 Workers’ Compensation Benchmarking Study. Citing best practices from The Hartford, CNA, Nationwide, and Albertsons, Rising recently released a white paper examining how claims advocacy principles are better suited to overcome psychosocial factors than adversarial, compliance-driven, and task-based claims styles. I have

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Medical Concierge Approach to Handling Claims

This article highlights issues the City of Ft Worth is having with their workers’ comp Third Party Administration services. I never know what is true or not in the press, but some of the employees’ comments imply there could be some real issues. One thing jumped off the page to me in reading the article: the difference

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