Claims Adjudication

Hospital groups express concern over earlier court ruling that could expand False Claims Act liability

The groups argue that allowing FCA claims to be brought for post-termination actions would defy congressional intent and leave hospitals subject to excessive financial liability.

Nick Hut October 19, 2021

AMA releases 2022 CPT code set with new options that apply to COVID-19 vaccination, digital care services and more

The new set features more than 400 CPT code changes from 2021.

Nick Hut September 10, 2021

UnitedHealthcare reverses course on new approach to emergency department claims, but perhaps only temporarily

UHC had announced this week that it would evaluate claims starting July 1 to determine whether ED visits were for emergent or nonemergent events.

Nick Hut June 10, 2021

Looming UnitedHealthcare policy on coverage of emergency department care draws opposition from hospitals, physicians

In a move strongly opposed by provider associations, UnitedHealthcare soon will start denying coverage of ED care that it deems to have been nonemergent.

Nick Hut June 10, 2021

New HRSA funding is available to providers that administer the COVID-19 vaccine and don’t receive full payment from a health plan

The Health Resources and Services Administration announced a new program to reimburse healthcare providers for administering COVID-19 vaccines to patients whose health plans either do not cover vaccination fees or require cost-sharing.

Nick Hut May 4, 2021

Questions remain on HRSA’s FAQs on billing uninsured COVID-19 claims

HFMA's Chad Mulvany says it's unclear whether IME and DSH payments are included in the "Medicare rates" that HRSA will pay hospitals for treating COVID-19 uninsured patients.

Chad Mulvany, FHFMA May 13, 2020

Why removing percent-of-charge provisions in managed care contracts won’t address concerns about high hospital charges

Removing percent-of-charge provisions in favor of fixed fees would not remove the factors that drive price increases, nor would it reduce administrative hassles or decrease risk.

William O. Cleverley, PhD January 2, 2020

Legislative fight over surprise billing is nearing an end, congressional aide says

Congressional negotiators are said to be close to a compromise on legislation that aims to end surprise medical bills.

Rich Daly October 31, 2019

Vitalware: An all-encompassing, single-platform chargemaster solution

A leading chargemaster company discusses how its technology helps hospitals operate more transparently, price strategically and confidently run a compliant and efficient revenue operation.

HFMA October 30, 2019

Holliday & Associates: Comprehensive Charge Management Software

A charge management company discusses how it helps clients successfully manage charge processes, comply with changing coding and regulatory requirements, eliminate charge-related compliance risks and ensure accurate and appropriate reimbursement.

HFMA October 1, 2019
googletag.cmd.push( function () { googletag.display( 'hfma-gpt-leaderboard' ); } );