Balance Billing When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may...Read More
Understanding Observation Care. From the Valley Hospital, Valley Health System. What is Observation Care? Observation services are hospital outpatient services that a physician orders to allow for testing and evaluation. This observation period, which normally...
By Kelly Gooch, Beckers Hospital Review. A recent investigation by the U.S. Office of Inspector General found between 2014 and 2016, Medicare Advantage organizations overturned 75 percent of their preauthorization and payment denials upon appeal. The OIG’s… Read More
By Michelle Andrews, Kaiser Health News. People with chronic conditions will be better protected from crippling medical bills starting in January as the health law’s coverage requirements and spending limits take effect. But a recent… Read More
By Julie Appleby, Kaiser Health News. If you buy one of the less expensive insurance plans sold through the health law’s marketplaces, you may be in for a surprise. Some plans will not pay for… Read More
By Jay Weaver, The Miami Herald One of the state’s wealthiest healthcare operators was arrested Friday at his Miami Beach waterfront estate on charges of orchestrating the nation’s biggest Medicare fraud scheme — $1 billion…. Read More
By Jodie Tillman, Condensed from the Tampa Bay Times. Even with in-network hospital, insurance may not cover ER physicians. When her husband, Charles, showed signs of heart trouble in January, Donna Baker didn’t hesitate to...
By Shelby Livingston, Modern Healthcare. The U.S. Justice Department has joined a whistle-blower lawsuit claiming that UnitedHealth Group and affiliated health plans have been gaming the Medicare program and fraudulently collecting millions of dollars by claiming… Read More
By FRED SCHULTE from Kaiser Health News. As Seniors Get Sicker, They’re More Likely To Drop Medicare Advantage Plans. A GAO report questions the quality of a number of Medicare Advantage plans after large numbers of...
By Scott Gottlieb, Pharma & Healthcare. Given the failed launch of Obamacare, there’s a real chance that the entire scheme falls into an “insurance death spiral” — but not as visibly (or rapidly) as the way… Read More