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Wrongly Denied Claims by Private Medicare Plans

Medisys Compliance

Recently published watchdog report found that private Medicare plans routinely rejected claims that should have been paid and denied services that reviewers found to be medically necessary. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules.

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Two Healthcare Organizations Caught Up in Medicare Fraud Schemes

Compliancy Group

In one incident, a New Jersey pharmacy admitted to conspiracies to defraud benefits providers, including Medicare and Medicaid, of $65 million for medications never provided to patients. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received.

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From Evolution to Innovation, from Health Care to Health: How Health Plans With Collaborators Are Re-Defining the Industry

Jane Sarashon

As a constant observer and advisor across the health/care ecosystem, for me the concept of a “health plan” in the U.S. Furthermore, health plan members now see themselves as medical bill payers, seeking value and consumer-level services for their health insurance premium investment. and ChatGPT.

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Understanding CPT Code 99214 – A Quick Guide

Physician Credentialing Company

In the healthcare sector, healthcare organizations and practitioners provide medical services to patients and ask for reimbursement in return from the insurers. Current procedural terminology (CPT) codes play a crucial role in the effective medical coding and billing process. When to use CPT Code 99214?

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Average Cost to Credential a Physician Provider

MedTrainer

Let’s take a look at the factors that can influence the cost of medical credentialing the most. What Is Medical Credentialing? Before you start asking how much credentialing costs, there’s an important question to answer first: What is medical credentialing? So how much does credentialing truly cost?

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Average Cost to Credential a Physician Provider

MedTrainer

Let’s take a look at the factors that can influence the cost of medical credentialing the most. What Is Medical Credentialing? Before you start asking how much credentialing costs, there’s an important question to answer first: What is medical credentialing? So how much does credentialing truly cost?

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100 Million People in America Are Saddled With Health Care Debt

Kaiser Health News

Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found. Debt levels in U.S.