We need entitlement reform and tax reform in order to restore a genuine free market and solve the government-created third-party payer crisis. And to bolster the case for reform, we’re going to look at three new examples of how government intervention makes the healthcare system worse rather...
(Lisa doesn’t only write. She makes stuff happen. While I’ve been trying to work within the “system” she’s been the motivating force for the community acupuncture business model, which made huge strides in making acupuncture accessible without depending on our flawed third party payer syst...
Given the audit structure, the rule specifies that smaller entities are much less likely to have their records audited. The rule also confirms that it imposes no new information collection requirements—e.g. reporting, record-keeping or third-party disclosure requirements. We anticipate that CMS wil...
The effect of hospice on third-party payer costs has long been of great interest in the United States and other nations. The choice of hospice could also influence the costs experienced by patients and family members as compared with when Medicare beneficiaries choose to use normal care. This ...
Are Third-Party Payers using NCCI Edits? There are several payers that have adopted CMS National Correct Coding Initiative (NCCI) edits and have implemented them into their claim scrubbers, such as Blue Cross and UnitedHealthcare. Due to the fact that NCCI edits are based on AMA CPT coding ...
(MSP) compliance services by providing Medicare Set Asides (MSAs), conditional payment / lien services and related solutions to all stakeholders – including carriers, self-insureds, third-party administrators, and attorneys. J29’s team is comprised of some of the most trusted ...
To achieve their growth targets, payers will also likely expand their reliance on brokers and other third-party partners. Success will hinge on having clearly defined member journeys and integrated internal and external channels (for example, call centers and onboarding). Multidirectional, real-time ...
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We draw on extensive industry knowledge, a deep pool of experts, and decades of service to the healthcare sector to support clients across the value chain and provide distinctive insights. Our teams collaborate with payers, provider systems, PBMs/pharmacies, private equity, third party solution ven...
An estimated 5–10% of breast and ovarian cancers are due to hereditary causes such as hereditary breast and ovarian cancer (HBOC) syndrome. Medicare, the third-party payer that covers 44 million patients in the United States, has implemented a set of clinical criteria to determine coverage for...