Articles Tagged With: claims
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Department Saw Worse QA Outcomes Initially
Marion (IN) General Hospital’s patient access department saw worse quality assurance outcomes shortly after implementing a QA tool. However, this decrease was expected, because the quantity of data elements being final-reviewed was greatly increased.
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Auth in Place, Then Different Procedure Is Done? Avoid “No Auth” Claims Denials
When a physician orders a procedure to be performed in a surgical setting at Birmingham, AL-based UAB Hospital, patient access staff start the process of obtaining required authorizations.
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Tenet to pay $238 million for false claims
Tenet Healthcare in Dallas has agreed to pay $238 million to resolve a False Claims Act lawsuit involving alleged kickbacks for maternity referrals by four of its hospitals.
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More nurses, hospitalists being sued for malpractice, studies say
Separate reports indicate that nurses and hospitalists are being sued for malpractice more than in the past.
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Communication failure cited in 30% of med mal
Thirty percent of all medical malpractice claims involve a communication failure, according to a new report. These claims involve communication breakdowns in which acts, figures, or findings got lost between the individuals who had that information and those who needed it, across the spectrum of healthcare services and settings.
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Prevent denials in the first place — Training is ‘paramount’
Errors or typos made by registrars during the collection of information or during the data entry process are “extremely prevalent” in claims denials, according to Brinn Leach-Wilson, a Merritt Island, FL-based consultant with BHM Healthcare Solutions.
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Did payer deny claim? Look closely to see if contract allows it
Many patient access leaders are seeing a sharp increase in claims denials, primarily due to more numerous and stringent payer requirements.
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DOJ recovers $1.9 billion from healthcare FCA cases
The Department of Justice obtained more than $3.5 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30, and $1.9 billion came from companies and individuals in the healthcare industry.
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Justifying short inpatient stays just got easier — or did it?
The Centers for Medicare & Medicaid Services has modified the controversial two-midnight rule to allow shorter stays to be billed as inpatient stays based on the physician’s judgment, but the change means that complete documentation is more important than ever before.
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Hospital to pay $72.4 million to settle Medicare False Claims case
Tuomey Healthcare System in Sumter, SC, will pay $72.4 million to settle a $237 million judgment following the Department of Justice allegations that it illegally billed the Medicare program for services referred by physicians with whom the hospital had improper financial relationships.