Medicare Audit on Therapy Claims

medicare-audit

Have you or your treatment facility ever thought about what potential changes are coming from Insurance Companies? What about the outlook for reimbursement in 4th Quarter or 2017? 2016 has seen massive sweeping changes in reimbursement rates in the first 8 months alone. The transition from ICD-9 to ICD-10, changes in medical necessity criteria and accepted CPT coding have all impacted a vast majority of treatment providers. Changes like these will continue as the industry evolves. Medicare has issued a review for 60 minute psychotherapy sessions as a potentially over used CPT code. What this means is that claims being.

Providers Steering Clients to Obamacare

steering-to-obamacare

This article contains important information for any facility accepting medical insurance as payment for services. Reports state that the federal government has launched investigations into healthcare providers steering and/or assisting patients into Healthcare Exchange policies when oftentimes the patients qualify for Medicare or Medicaid. Steering patients to specific policies, insurance plans, or markets drives up healthcare costs. In turn, higher costs equate to increased premiums and increases the cost of coverage for all. With health insurance, if the risk pool gets to diluted with sick or treatment seeking people, insurers begin to experience great losses. As a result, insurers begin.

The Business of Health Insurance

The Health Insurance Exchanged launched in 2014. Since it’s launch, insurers have been struggling to maintain reasonable margins. Major carriers are posting astronomical losses. This in turn is effecting insurance premiums for the working class. Lets take a look at North Carolina, For the insurance companies doing business in the state–the ones issuing policies to those 600,000 people–Obamacare has turned into a financial sinkhole. UnitedHealth Group, the nation’s largest insurance company, is pulling out of the Obamacare business in North Carolina next year. Blue Cross Blue Shield of North Carolina, which dominated the individual market with more than a half-million.

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