“Operation Spinal Cap” Uncovers $600M in Healthcare Billing Fraud

“Operation Spinal Cap” Uncovers $600M in Healthcare Billing Fraud

The former CFO of a Long Beach hospital in California, two orthopedic surgeons and two others have been charged in relation to a $600 million fraudulent billings scheme involving illegal referrals of thousands of patients for spinal surgeries.

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Why Humana is Giving $77M to Various Physician Groups

Why Humana is Giving $77M to Various Physician Groups

Humana will distribute $77.2 million in bonus payments to roughly 3,700 physician groups nationwide who were engaged in its Provider Quality Rewards Program in 2014. The goal is to increase the 59% of Humana individual Medicare Advantage members who have primary care physicians participating in value-based relationships, to 75% by the end of 2017.

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Kareo Video: How to Manage Your Denials Post ICD-10

  1. "Closely monitor denials and rejections" and this should be done daily.
  2. "Watch for denial trends." Where are these denials coming from and why?
  3. "Make changes based upon denial reasons." 
  4. "Be prompt." Identify the problem and quickly implement a plan to fix it.

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Revenue Cycle Integration is Well Worth the Investment

Revenue Cycle Integration is Well Worth the Investment

The vice president of Revenue Cycle Organization at Intermountain Healthcare, Todd Craghead, began consolidating revenue cycle functions across 22 hospitals and over 100 physician clinics in a 10 year process. According to Craghead, "One of the things that was apparent was the pressure on administrative costs to the health system.

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Turning Doctors Into Business Robots is Bad For Everyone

Turning Doctors Into Business Robots is Bad For Everyone

According to a headline in a local newspaper, SystemCare Health in NJ promoted a graduate of college to the position of Senior Director of Doctivity. Doctivity was not easily defined on the Internet, so Walter Brasch curiously did some digging into SystemCare Health’s website.

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