Governance Health Insurance Payment Systems 
MRO Compliance
MAY 15, 2025
In the healthcare ecosystem, a payer is any entity such as a private insurer or government program, that finances or reimburses the cost of health services. Health plans, offered by these payers, provide specific coverage for various medical needs.
MedTrainer
JANUARY 12, 2024
Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. What is Healthcare Compliance?
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The Digital Health Corner
APRIL 28, 2017
This type of payment system shifts the ROI of digital technology from one based on revenue generation to cost savings. In fact arguments for consolidation are based on the promise of improved cheaper care. This has yet to be demonstrated (in healthcare or any other industry).
Physician Credentialing Company
OCTOBER 25, 2024
Insurance Verification And Pre-Authorization Before delivering services, it’s very important for healthcare providers to check whether the patient’s insurance includes mental health services under the 90834 code or not. Medicare and Medicaid may have different payment systems from those of the private health insurance plans.
C&M Health Law
AUGUST 3, 2023
OIG differentiated the vetting Health Insurance Portability and Accountability Act (“HIPAA”) covered entities may conduct of entities that would be their business associates before granting access and use of EHI. Additionally, such vetting applied in discriminatory or unreasonable manner could implicate information blocking.
AIHC
NOVEMBER 29, 2023
Prior to this time, commercial carriers were already pushing HMOs (health maintenance organizations) and capitation contracts with physician networks or instituting “reasonable and customary charges” requiring physicians to collect data to negotiate reasonable contracts. Hospital reimbursement also changed.
Health Care Law Brief
JULY 25, 2023
Unlike developers, exchanges, and networks, the Act does not empower OIG to directly assess penalties for non-compliance against health care providers. [6] 3] Given the foregoing statement, OIG enforcement actions, at least as a preliminary matter, are likely to focus on repeat offenders, or particularly flagrant conduct.
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