Emergency medicine (EM) has always been subject to payer scrutiny, but today’s reimbursement pressure is different: it is more aggressive, more automated and less transparent. Across the country, EM ...
With the red tape of health insurance already causing frustration for millions of Americans, doctors are helping to shed light on a common industry practice: downcoding. Insurance companies change ...
Doctors say insurers are automatically downgrading their claims and paying less. Insurers say it’s their duty to prevent overbilling. In the beginning of the year, Dr. Terry Wagner’s office manager ...
Insurance companies continue to innovate. On Oct. 1, Cigna will roll out a policy that tracks how physicians bill. It will flag those who submit a higher proportion of level four or level five visits ...
In the vast majority of states, hygienists cannot legally diagnose dental disease. Even in the few states that are the exception, diagnosis is limited to the scope of care delivered by hygienists and ...
High-intensity billing during "treat and release" emergency department stays rose significantly from 2006 to 2019, and was partially fueled by factors such as changes in case mix and service offering ...
UnitedHealthcare axed Envision from its network in early 2021, saying that Envision's high costs did not reflect fair market rates. (SomeMeans/GettyImages) UnitedHealthcare's war with physician ...
Health plans are using both new and old methods to deny healthcare providers’ claims, all of which are legally and factually unsupportable. These tactics have repeatedly been rejected by arbitrators ...
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