Find Out Where You Stand Today on This Controversial DME Prior Authorization Rule

December 14, 2017 / 0 Comments

Becker’s announcement on CMS’ DME prior authorization rule came a while back, but CMS’ stance on prior authorization is likely still causing denial issues for your facility today. The Backstory Just as 2016 was about to round the corner, CMS issued a rule requiring prior authorization before Medicare would reimburse DME that had been found…

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A Revenue Cycle Turnaround Case Study

December 14, 2017 / 0 Comments

We recommend you buy a Starbucks coffee and set aside an hour to watch the “Coffee With Coker” presentation entitled “Revenue Cycle Turnaround: Rebuilding for an Advanced ROI – A Case Study,” which is archived here. Senior Vice President of Coker Group Jeff Gorke takes us through the components and challenges of building and maintaining…

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Telemedicine’s Newest Threat. DME Denials?

December 6, 2017 / 0 Comments

A recent report from Grand View Research reveals a potentially hidden threat to telemedicine programs. We’re all aware that chronic disease is a growing problem around the world, but did you know that the diabetic foot ulcer treatment market alone is valued at over $3.15 billion?  Statistics like that mean the results of a report…

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The New Age of Check Fraud

Bank Complexity/Paradox Holds Back Innovation in Check Fraud Prevention

December 5, 2017 / 0 Comments

Fraud prevention solutions have evolved significantly in the past 3-5 years in terms of improved analytics, business intelligence, risk scoring, image analysis, platform deployment, and decision support. However, the deployment cycles of these solutions can be complex and challenging. When you weigh IT overhead, project costs, systems integration, security, infrastructure — just to name a…

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62 Hospitals Sued for Fraudulent Patient EHRs and Falsified Claims

December 1, 2017 / 0 Comments

EHR Intelligence reports on a whopping sixty-two Indiana hospitals being sued in a federal civil lawsuit for allegedly falsifying records and participating in a kickback scheme, primarily by overbilling for the release of patient Electronic Health Records. As reported in The South Bend Tribune: Memorial Hospital of South Bend, Saint Joseph Regional Medical Center in Mishawaka,…

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Good News for Banks: FDIC-Insured Income 5.2% Higher Than Last Year

November 30, 2017 / 0 Comments

The FDIC’s quarterly Banking profile contained good news for their client banks. FDIC-insured commercial banks and savings institutions are reporting third-quarter 2017 earnings of $47.9 billion — that’s 5.2% year over year. Community banks make up 92% of all FDIC-insured institutions; they reported net income of $6 billion, up 9.4% from last year. Also, Net Interest…

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CPAP Denials Are A Bigger Deal Than You Thought.

November 28, 2017 / 0 Comments

Earlier this year, The Huffington Post reported on the largely negative impact Medicare regulations are having on CPAP users and providers. On the provider side specifically, CPAP denials have been known to top denials lists for HME and DME suppliers, meaning that understanding the layers of Medicare’s logic is the first step in understanding how…

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Are You Analyzing Your DME/HME Claims Denials?

November 22, 2017 / 0 Comments

The CHANGE HEALTHCARE HEALTHY HOSPITAL REVENUE CYCLE INDEX estimates that out of the $3 trillion in claims that were submitted in 2016, 9 percent ($262 billion in charges) were initially denied. For your average health system, that adds up to as much as 3.3 percent of NPR, dinging them for an average of $4.9 million…

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RCM Needs To Accept Millennials

November 21, 2017 / 0 Comments

Becker’s ASC Review reports that Millennials, or individuals born roughly between 1980 and 2000, now number 73 million in the United States (according to the polling firm Gallup). They are well on pace to soon outnumber Generation X — their immediate predecessors — at all U.S. companies. For review, here’s a timeline (just one of many…

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Australia’s New Payments Platform: Watch Out for Fraud, Say Experts

November 20, 2017 / 0 Comments

The Land Down Under is introducing New Payments Platform (NPP), the modestly-named and soon-to-be-launched system that will enable almost instantaneous transactions between banks and bank accounts, any day of the week. With convenience comes a level of jeopardy. Finder.com.au insights manager Graham Cooke told The New Daily that the new platform could expose consumers to fraud risks. “While…

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