Identifying and preventing health care fraud
Instances of health care fraud account for billions of dollars of lost revenue a year throughout the industry. Without the correct safeguards installed to help identify and end fraudulent practices, health care providers could face investigations and penalties that...
Uncertain diagnosis terminology gets update for ICD-10 2020
The FY2020 ICD-10 guidelines, which went into effect October 1, included the addition of “compatible with” or “consistent with” to terminology that cannot be used to indicate uncertain diagnosis for outpatient services. In the guidelines, CMS states the following: “Do...
Aetna to end payments for PC of clinical pathology Aug. 1
Aetna will no longer pay for the professional component of clinical pathology beginning Aug. 1. While the insurer initially ceased in-network payments for the professional component of clinical pathology services around 2005, many groups have remained out of network...