Jul 9th, 2018
A former fraud investigator for Anthem, Inc. is one of five people indicted on federal healthcare fraud charges. Those indicted participated in a multi-year scheme to commit fraud against at least eight health insurance companies. The fraud investigator from Anthem provided the other defendants with confidential Anthem information that assisted them file fraudulent claims to ...
In Billing
Mar 1st, 2018
Anthem has sent a letter to the AMA to announce  they are rescinding the policy reducing payment for physicians when billing an E/M with a modifier 25 and a procedure that has zero or 10 global days. Anthem was planning on taking a 25 percent reduction on all 25 modified services billed with minor procedures as ...
On November 19, one of the nation’s largest insurers announced they were second guessing their choice to sell coverage in the Affordable Care Act’s individual markets for 11 states. According to MSN, UnitedHealth’s “Losses from the plans this year and next will total more than half a billion dollars.” Although UnitedHealth was late to join ...
Mar 25th, 2015
Those who work in the healthcare industry know all too well how important it is to protect the health information entrusted to them. That doesn’t make the task any easier. Even large health insurance companies with megabucks to spend on securing their clients’  health information are vulnerable to the attacks of cyber criminals—even Premera Blue Cross. ...
May 1st, 2012
With so many different interpretations to coding rules, your practice can’t afford not to create one. By Pam Brooks, CPC If coding were described as a color, it would be gray. Even with CPT®, ICD-9-CM, and HCPCS Level II guidelines, and despite regulatory guidance from the Centers for Medicare & Medicaid Services (CMS), the Office ...