An ongoing concern within every payer’s special investigation unit (SIU) has been how to adapt existing investigations and future analytics to ICD-10 codes. The thought of having to recreate years of investigative knowledgeware is daunting enough, but the thought of having to figure out the ICD-10 equivalents of the ICD-9 based knowledgeware make it feel akin to climbing Mount Everest. But those ICD-10 codes are hiding out and getting exploited, so something must be done. Con ...

As long as there is profit incentive, fraud by wrongdoers can enter into the healthcare spectrum at any point.  An increasingly common fraud scheme surrounds the care of the end-of-life patient in the hospice setting.  In order for most payers to cover a patient receiving hospice care, a physician’s written certification that the hospice patient is terminally ill with a life expectancy of six months or less is typically required.  Enter the fraud scheme – false certif ...

Context4 Healthcare, Inc.is set to attend the 2015 CAH Conference, presented by the Illinois Critical Access Hospital Network (ICAHN), being held November 11-12, 2015 at the Crowne Plaza Hotel in Springfield, IL. According to ICAHN's conference website, this year's "theme, 'Strengthening Our CAHs and Their Communities', centers around the importance of critical access and small and rural hospitals and their vital role in attaining and improving population health."

Conference attendees will have the chance to learn about a new product this year - just recently, Context introduced a new Inpatient UCR module as part of its DecisionPoint™ Health Payment System. With the increasingly high cost of inpatient services, many valued UCR customers have been looking for a way to benchmark inpatient facility claims. As the trusted source for UCR fee data (including Medical, HCPCS, Anesthesia, Dental and Outpatient), Context has developed an independent source for inpatient charges for more than 740 Diagnosis-Related Groups (DRGs).