The Centers for Medicare & Medicaid Services’ (CMS) current and proposed reforms may not be enough to eliminate the appeals backlog and restore a timely and fair appeals process. That was the finding of a study published recently in the Journal of Hospital Medicine. Researchers investigated all appeals reaching level three at three facilities: Johns…

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The Centers for Medicare and Medicaid Services (CMS) wants to help healthcare providers to determine whether they must take part in the Merit-Based Incentive Payment Program – better known as MIPS. The new Medicare reimbursement program is central to the Quality Payment Program, which intends to shift reimbursement away from the volume of services provided…

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Is it the government’s “murky policies,” as suggested by a UnitedHealth spokesman, or was it outright fraud that led to allegations the healthcare insurance giant engaged in fraud? That’s a question that will have to be answered following the U.S. Department of Justice’s recent decision to intervene and file a complaint against UnitedHealth Group (UHG).…

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The recent announcement by The Department of Health and Human Services’ Office for Civil Rights (OCR) that it agreed to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) with The Center for Children’s Digestive Health (CCDH) should serve as a lesson to other healthcare organizations about the need to obtain signed,…

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