In May 2022, a California doctor was sentenced to nearly eight years in prison for his involvement in a $12 million Medicare fraud scheme. His crime: performing unnecessary vein ablation procedures on patients, and using incorrect billing codes to receive larger reimbursements. He received $4.5 million in reimbursements from Medicare over a three-year period.
Compared to this example, most instances of “upcoding” and “overcoding” are not as malevolent or expensive. But even an
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Innovation Key to Tackling Medicaid Redetermination Challenge
As a result of the Families First Coronavirus Response Act (FFCRA), Medicaid programs were required to keep citizens continuously enrolled through the COVID-19 public health emergency (PHE). These continuous enrollments ended on March 31, 2023, resulting in what many call the unwinding of Medicaid.
In June, the Kaiser Family Foundation (KFF) estimated that between 8 million and 24 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision. The
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Enterprise Imaging: What is the Market Opportunity Beyond Radiology?
The concept of an enterprise imaging strategy was coined over a decade ago, however, it’s only in recent years that the expansion beyond “enterprise radiology” has truly begun. The total market for IT across those nine specialties included in Signify Research’s report reached $6.6 billion in 2022; however, only 20% of market revenue was associated with enterprise deals. When digging deeper into which specialties led the enterprise trend, radiology represented 71% of the total enterprise imaging
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No More Surprises: Automation Ensures Compliance, Mitigating Penalties
The No Surprises Act (NSA) is a bipartisan effort to protect patients from unexpected healthcare expenses. This law is good news for patients, with a KFF poll showing that 1 in 3 insured adults between 18 and 64 received an unexpected medical bill in the prior two years. The NSA aims to make the cost of care more transparent and minimize surprise billing, which can cause significant financial burdens through higher out-of-pocket expenses and denied claims. Under the NSA, patients now receive
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Ozempic: From Diabetes Management to Potential Weight Loss Miracle
You've probably heard about Ozempic, especially if you're one of the millions who regularly scroll through TikTok or browse other social media platforms. It's the drug that influencers are lauding as a revolutionary aid for weight loss, making it a hot topic of conversation.
While Ozempic was initially developed to manage Type 2 diabetes, its emerging potential for weight loss is captivating medical professionals and the public alike.
How Ozempic Works: The Basics
Ozempic is a
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Embracing a Forward-Thinking Vision to Address the Senior Care Crisis
A demographic shift is looming, and we aren’t as prepared as we think.
Colorado has long been revered for its stunning landscapes and outdoor pursuits, earning a reputation as a state with a youthful and active population – but, we are aging.
By 2050, Colorado’s number of older adults is expected to more than double to 1.7 million, second only to Alaska in the U.S. for the fastest-growing population of people over 65. Nationwide, the 85 and older population is projected to more than double
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The Case for a Credential Wallet in Healthcare Staffing: Increasing Efficiency, Compliance & Profit
Healthcare staffing, an essential pillar of the U.S. healthcare system, involves a myriad of entities, including healthcare providers, facilities, staffing agencies, credentialing bodies and regulatory agencies. At the heart of this process lies the critical function of credentialing — the rigorous verification of clinician qualifications–and how the system is reimbursed. As the industry grapples with a profound staffing shortfall, all stakeholders in the healthcare industry need to focus on
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The Role of Qualified Medical Interpreters in Achieving Section 1557 Healthcare Compliance
For the last decade, Section 1557 has been at the center of many changes and today, it continues to be as the Biden administration is working to take giant steps towards restoring and strengthening some civil rights protections for people in many health-related programs and activities that receive funding from the federal government.
Section 1557, known as the “Health Care Rights Law,” is the main nondiscrimination provision of the Affordable Care Act (ACA). It prohibits discrimination in
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Digitizing and Streamlining Surgeon Preferences Improves Operational Efficiency and Patient Safety
In the dynamic world of healthcare, preference cards serve as crucial tools that capture a surgeon’s specific needs and preferences for each type of surgical procedure they perform. These cards typically outline the equipment, instruments, and supplies required for a particular procedure, providing a personalized roadmap for surgical teams to follow. By detailing these specifications, preference cards help streamline surgical planning, foster improved communication among the operating room (OR)
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Automation Fills Gaps Left by Revenue Cycle Talent Shortage
Healthcare providers are feeling the industry’s talent shortage in their administrative functions as well as clinical areas. One case in point: revenue cycle management. In a recent study, 63% of healthcare providers reported an inability to fill key revenue management roles. Reduced revenues and cash reserves are almost inevitable when providers don’t have sufficient staff to follow up on claims, manage appeals and help patients understand their financial responsibilities and
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