Compliance & Legal

Mar 30 | Susan Morse

DOJ accuses Anthem of fraud in risk adjustment payments for its Medicare Advantage plans

Anthem claims the DOJ has violated the law in holding Medicare Advantage plans to payment standards…

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Mar 23 | Mike Miliard

CMS offers quality reporting relief as providers battle COVID-19

It's granting exceptions and extensions from reporting requirements for clinicians and providers participating in…

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Mar 02 | Jeff Lagasse

FTC and Pennsylvania challenge proposed merger of two Philly hospital systems

The complaint charges that the merger would eliminate the competition that has traditionally benefited patients.

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Feb 28 | Jeff Lagasse

Michigan doc charged in $120 million healthcare fraud, money laundering scheme

Francisco Patino was allegedly portrayed as a legitimate doctor through the publication of a diet book and plan…

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Feb 26 | Mike Miliard

AMA launches new playbook to help providers with digital record sharing

AMA officials say the playbook aims to dispel some of the "myths and misconceptions from an array of complex…

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Feb 25 | Susan Morse

Appeals court upholds Trump Administration rule barring abortion referrals

American Medical Association says it will continue to fight the rule's effective 'gag' order on…

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Feb 24 | Jeff Lagasse

Affordable Care Act exchanges grow as insurer participation rises

In total, 245 individual insurance carriers took part in federal and state exchanges during the 2019-2020 plan year,…

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Feb 20 | Jeff Lagasse

Democrats debate healthcare reform

Study shows MFA could realize $450 billion in savings and prevent 68,000 deaths per year, though implementation costs would be high.

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Feb 19 |

More than $2 billion in fraud recoveries collected from healthcare companies last year

Providers warned to stay vigilant as financial and political incentives remain strong to bring False…

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"NJ Capitol" by Lowlova is licensed under CC BY 2.0

Feb 18 | Susan Morse

CarePoint hospitals require financial intervention, legislators say

New Jersey legislators told the governor they want CarePoint finances and transactions closely watched, in light of…

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Featured Resources

Beyond Dollars and Cents: A Closer Look At Value Beyond the expected improvement in specific metrics, many organizations that outsource RCM with a trusted and certified partner are seeing several ancillary benefits of such agreements.

Debunk the Myth: Outsourcing Doesn't Mean Losing Control With shifts in payer mixes and reimbursement structure, the margin of reimbursement has been shrinking steadily over the last five years. How do revenue cycle leaders navigate payment reform while maintaining stable business office operations?

Care Collaboration Success for Improved Outcomes The nature of our healthcare ecosystem has been one of siloed care. Rarely do payers, providers and local resources come together with the patient's well-being prioritized as a unifying mission. Read how these organizations are getting it right.

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Once-failing hospitals say accountability, transparency key to surviving fallout from failing patient safety grades When Leapfrog released their Spring 2016 patient safety grades recently, 15 hospitals got slapped with a very public 'F' grade casting a spotlight on them that no institution wants. ...

Healthcare mergers and acquisitions in 2016: Running list While 2015 was a record-breaking year in healthcare mergers and acquisitions, 2016 saw more change as organizations across the industry adjust and adapt to the evolving financial landscape.

Analyze this: Health systems, health plans get to the core of big data Pamela Peele knows that people who subscribe to cooking magazines have a much higher risk of going to the emergency room. But how she knows that is a whole other story.

Whitepapers

Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle Hospital systems across the country are looking to streamline their billing and collection processes to become more efficient and better compete in their markets. The challenge many face is how to turn the data ...

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