Do Risk Corridors Help Health Plan Beneficiaries?
The Supreme Court found that the U.S. Government breached a commitment to Pay $12 Billion to Health Insurers, but are these payments going to help beneficiaries? Introduction The U.S. Supreme…
The Supreme Court found that the U.S. Government breached a commitment to Pay $12 Billion to Health Insurers, but are these payments going to help beneficiaries? Introduction The U.S. Supreme…
This is a complex subject—first, some introductory concepts. Then, the details. In healthcare, the intersection of demand, price, quality, and suppliers' sources alone does not determine whether pricing is appropriate.[i]…
Use of Telemedicine During a Public Health Emergency DISCLAIMER This information and compliance guidance has been gathered and interpreted by No World Borders from various resources, including CMS, and Medicare…
Under Medicare, payments for services performed in provider-based facilities may be fifty (50) percent higher than payments for the same services performed in a freestanding facility. This increased cost is…
Five Types of Medicare Appeals, Medicare Part B There are five types of Medicare Appeals. The process differs slightly for Medicare Part A, Medicare Part B fee for service, Medicare…
What is the HITECH Act? An Introduction for the Layperson Money to convert from paper to electronic People who ask, "What is the HITECH Act?" should understand how the Act…
September 10th 2020 is World Suicide Prevention Day. CDC data indicates that suicide and suicidal ideation is higher in men aged 18-24, essential workers, blacks, and Hispanics who never graduated…
Medicare Inpatient Rehabilitation Facility (IRF) Coverage Medicare Part A (Hospital Insurance) covers medically necessary care that insured patients receive in an inpatient rehabilitation facility or unit (‘ inpatient ‘rehab facility, IRF, acute care…
CPT Test Procedure Codes for COVID-19 Testing COVID-19 testing and diagnosis codes are an essential component to collecting and analyzing data to understand the pandemic. U.S. Health and Human Services…
Home Health, Attendant Care, Respite Care Coverage, Coding and Billing Federal Medicare Home Health Care PPS Dates to Balanced Budget Act of 1997 The 1997 Balanced Budget Act (BBA), amended…
Pharmacy Benefit Manager Drug Pricing and MAC Appeals - PBM MAC Appeals Pharmacy Benefit Managers drug pricing uses several metrics and Standards. Pharmacy Benefit Managers (PBMs) may use Maximum Allowable…
Integrated Medical Bill Review and Subrogation Integrated medical bill review combines silos into one solution. This article provides a summary of various strategies to determine the value of medical bills. Plaintiffs in…