On March 17, 2023, the Centers for Medicare and Medicaid Services (CMS) instructed certified Independent Dispute Resolution (IDR) entities to restart making payment dispute determinations for items or services furnished on or after October 25, 2022, now that the governing standards have been updated.
Coordination of Benefits (COB) administration is a key component of a plan’s cost containment strategy and should be periodically evaluated by plan sponsors to ensure it is properly designed and working effectively.
Are you planning to conduct an audit of your health plan claims administration next year? Consider incorporating these recommendations for a more effective engagement.
Global maternity services consist of antepartum and prenatal services, delivery or cesarean section, and postpartum care. Providers tend to use the global code in lieu of billing individual services because some insurance carriers will deny payment due to “unbundling.”
In order to properly manage a health plan, the plan sponsor and its board need to receive a good deal of financial and non-financial data. Board reports will come from many sources so compiling this information into a concise reporting package is often difficult, but vital.
As phase two of the Healthcare Transparency Act is quickly approaching, we wanted to discuss what is in the plan, what it means, and how it will impact plan sponsors.
When constructed properly, performance guarantees serve as an objective means for the plan sponsor and its vendor to ensure the service provider is meeting the contract’s expectations.
Learn about the increase in cyber attacks aimed at healthcare processors, including what to look for and how to protect your organization.
Whether it was ignorance, lack of oversight, or something more nefarious, state agencies in Georgia, Colorado and California are cracking down on insurance companies that are running afoul of the rules.
End-Stage Renal Disease is a life-changing disease for employees and a catastrophic health plan expense for employers, so plan sponsors need their insurance carriers to help employees stay healthy in order to control costs, as well as coordinate with Medicare.
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