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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The Road to Optimal Opioid Prescription Length

The Centers for Disease Control and Prevention (CDC) estimates that the total economic burden of prescription opioid misuse in the United States is $78.5 billion a year. Most of that burden is related to workplace costs, such as lost productivity, prolonged time on disability, and increased work disability claim costs. To help combat this crisis, organizations

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The Future is Now – Telemedicine in the Marketplace

For years, telemedicine has been touted as the next frontier in healthcare. Based on data from multiple health systems, the future has arrived. Some of the country’s largest and most prestigious health systems such as Kaiser Permanente, NewYork-Presbyterian, and Johns Hopkins now boast robust telemedicine programs. At Kaiser Permanente, virtual patient encounters now outnumber in-person

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Big Differences Between Three ICD-10 Coding Systems

Here are some interesting facts about ICD-10 that may not be commonly known. International Classification of Diseases (ICD) was created by the World Health Organization (WHO), which has served the healthcare community for over a century. While most industrialized countries moved to the ICD’s “tenth revision” – ICD-10 – 30 years ago (1983), the United

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Largest Single Healthcare Fraud Case in U.S. History

The U.S. Justice Department just recently indicted three Florida residents in the “largest single criminal healthcare fraud case ever brought against individuals.” While the case has not gone to trial yet, the numbers are staggering. It is alleged that over $1 billion in Medicare and Medicaid billings were fraudulently charged by just a few co-conspirators –

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War of Mergers

I have previously written about the increased pace of medical provider/hospital mergers since the Affordable Care Act was passed. By consolidating choices and moving more services into hospital settings, where pricing is much higher for the same treatment, facilities are able to negotiate better PPO rates, increase revenue, and improve profitability. This exact same trend

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