Topic: Billing and Coding
A class-action lawsuit filed last week accuses Cigna of colluding with an administrative claims vendor in a cost-shifting scheme to overcharge members.
UnitedHealthcare plans to cut ties with Envision, citing "highly questionable billing practices" and hinting at "millions of dollars of overpayments."
It's part of a broader trend in the industry caused by the rise of electronic health records.
Physician offices spend a lot of money on billing costs, and a new study finds they deal with $11 billion in challenged revenue annually from insurers.
A former CareFirst broker has been charged with fraud, and the OIG says 61% of physical therapy claims were improper.
UnitedHealth plans to scrutinize high-cost ER claims and perhaps downcode or reject them entirely.
Orthopedics is the medical specialty with the highest out-of-pocket cost estimates for patients.
The AHA has joined the chorus calling for further changes to Anthem's ER payment policies.
Anthem has decided to rescind a policy that would have reduced payment to doctors for certain same-day services.
Hospitals may offer low-interest loans to patients to ensure payment, but some question the practice.