Claims Processing
The Texas Supreme Court has denied an attempt by 14 hospitals to force the state Health and Human Services Commission to recalculate and repay the difference on past Medicaid claims.
One of the principal arguments for passing healthcare reform legislation circled around the theory of cost shifting. In essence, when hospitals care for uninsured patients that don't pay bills, or when they receive low reimbursements for Medicare or Medicaid patients, they charge insurers higher fees to make up for the losses.
Florida and the Centers for Medicare & Medicaid Services (CMS) need to determine whether the state should repay the federal government for $12 million in Medicaid overpayments, the Department of Health and Human Services' Office of the Inspector General (OIG) recommends in a new report.
Louisiana Department of Health and Hospitals Secretary Bruce Greenstein is resigning on May 1, amid state and federal investigations into a $185 million Medicaid contract awarded to a company where he briefly worked.
After a federal district judge temporarily blocked a Georgia prompt payment law applying to self-funded plans and third party administrators (TPAs), the American Medical Association (AMA) is challenging some of the pillars of federal preemption under the Employee Retirement Income Security Act (ERISA).
Bundled payment and payment reform in general are hot topics in healthcare circles, and will prove to be a challenge for many. Jay Sultan, thought leader for payment reform at TriZetto, a healthcare management solutions company, shared with Healthcare Finance News five key ideas for hospital leaders to consider in order to break barriers to successfully implement payment reform at their organizations.
Last week New York Attorney General Eric T. Schneiderman announced a $3.1 million settlement with Excellus BlueCross BlueShield requiring the insurer to refund 12,000 plan members who overpaid their healthcare providers as a result of the company's improper accounting of deductibles.
Helping providers prepare for what some have called a coming reimbursement war, the tech firm SAI Global Compliance has unveiled an application called the "Claims Denial Manager," designed to limit losses from pre-payment claims denials. 
According to Suzanne Menard, Revenue Cycle Director at Southern Maine Medical Center (SMMC), some of the most important keys to implementing a successful Point of Service (POS) collection program include clear objectives presented to all hospital committees and comprehensive training programs for involved staff members.
With childrens dental coverage set to expand in the next few years, the dental industry is trying to get a sense of what the dental insurance market, and the state and federal rules impacting it, might look like.
SCAN Health Plan, a California HMO, is paying the state of California and the federal government $323 million in fines for Medicaid and Medicare overpayments, some going back to 1985.
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