When fraud causes patient harm, and how to find it before it does
by Cindy Gallee, JD, RHIA, CHC It’s been called the most sinister, the most egregious, the worst kind of health…
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Healthcare Fraud and Abuse Schemes – How to Spot the Patterns
by Emilia Burlasz Before the use of electronic claim submissions and EHRs, the only option payers had to detect fraud,…
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Dental FWA – Upcoding, Misrepresentation and Diagnosing Unnecessary Treatment
by Cindy Gallee, JD, RHIA, CHC Dental fraud, waste, and abuse (FWA) is often unchecked as most Payer’s dental insurance…
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Virtual Benefits Administrator and Context4 Healthcare, Inc. announce real-time Medicare pricing automation
by John Danza Virtual Benefits Administrator and Context4 Healthcare, Inc. are pleased to announce the release of real-time Medicare and UCR pricing….
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Payment Integrity and ACO Success
by Margaret Klasa DC, APN BC Various payment models are the trend for the healthcare industry today and will be…
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EHR systems can’t protect you from the False Claims Act
by John Danza The recent Department of Justice (DOJ) $155 million False Claims Act settlement with eClinicalWorks highlights a problem that…
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Medicare Advantage Plans Under the FWA Microscope
by Margaret Klasa DC, APN BC HEALTHCARE is again the most popular topic for the past few weeks. Even friends that…
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Payers Use UCR Data to Drive Behavioral Health Outcomes
by Margaret Klasa DC, APN BC Payers will be asked to drive population health outcomes as ACA and payment models…
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CodeLink Pro® 2017 Now Boasts Medical Necessity with Bill Editing
by Margaret Klasa DC, APN BC Context4 Healthcare is proud to announce that its flagship CodeLink Pro® medical coding compliance…
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Why Your EHR System Might Get You Audited: ICD-10 Dropdown Menu Fails
by Margaret Klasa DC, APN BC The ICD-10 transition was completed over a year ago. Most providers and payers have…
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RAC Ramp Up for 2017
by Margaret Klasa DC, APN BC The five regional Recovery Audit Contractors (RACs) are ramping up their automated and complex…
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OIG Work Plan FY-2017 – Monitoring Claims for Potential Fraud
by Cindy Gallee, JD, RHIA, CHC The Office of Inspector General (OIG) Work Plan for Fiscal Year 2017 provides useful…
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