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Avoiding Red Flags: Finding the Right Productivity Balance

Healthcare IT Today

After all, more patients should generate more billable services—and thus, more payments. But as organizations balance productivity goals with payer policies, sometimes their version of “enough” patient volume is actually too much. The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing.

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These are the compliance issues providers should be preparing for, post-PHE

Healthcare IT News - Telehealth

Additionally, several telehealth flexibilities (that generally expand Medicare coverage for telehealth services) have been extended 151 days (about five months) beyond the termination of the HHS PHE. If Medicare coverage requirements for telehealth services (e.g., If Medicare coverage requirements for telehealth services (e.g.,


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Navigating the Intersection of Payment Integrity and Provider Relations in Healthcare

Innovaare Compliance

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 A survey by the American Medical Association found that 92% of physicians reported that prior authorization requirements had a negative impact on patient clinical outcomes. 2021, January 15). 2021, April).

Fraud 52
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Introduction to Telebehavioral Health


Increasing importance on patient satisfaction, providing efficient and quality care, and minimizing costs have also led to higher telehealth implementation. Medicare covers many telebehavioral and telemental health services including audio-only services. This is also called “store-and-forward telemedicine.”

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Health Provider News – October 7, 2022

Hall Render

Judge orders Anthem to face lawsuit over alleged Medicare overpayments. Delaware retirees protest switch to Medicare Advantage plan. Bayfront Health takes in ICU patients evacuated from Lee Memorial, recovering from Hurricane Ian. Medicare cuts concern Kentucky home health leaders. but state officials optimistic.

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Health Provider News

Hall Render

To qualify, facilities must close their beds Amazon’s physician acquisition strategy As Many Hospitals Continue to Face Significant Financial Challenges, MedPAC Recommends Highest Ever Medicare Payment Update Change competitors step in but breaking up may be hard to do CMS to launch new primary care ACO program Congress unveils $1.2T

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KHN’s ‘What the Health?’: Finally Fixing the ‘Family Glitch’

Kaiser Health News

Meanwhile, open enrollment for Medicare begins Oct. 15, when beneficiaries can join or change private Medicare Advantage plans or stand-alone prescription drug plans. Many seniors are happy with their Medicare Advantage plans, which often offer more benefits than traditional Medicare at a reduced cost.