The real issue isn’t one payer, one policy or one bad actor. It’s a deeply fragmented system built on competing incentives, misaligned responsibilities and layers of administrative friction.
The future of telehealth is trust, combined with patient education. As the market matures, all parties — providers, regulators, and platforms — must collaborate to sustain that trust.
Greenway Health blends smart technology with human expertise to elevate revenue cycle.
AI can be a highly effective tool for plans aiming to reduce fraud, waste and abuse, but only if it is combined with investigative intelligence.
Business and compliance considerations for MSOs and PCs, the contractual structure, and general recommendations for establishing a model that runs efficiently and mitigates levels of risk
By being aware of the latest schemes, health plan leaders can ensure their members have appropriate access to care while preventing bad actors from exploiting telehealth policies established during the pandemic.
Coordination of benefits is a critical pillar of the Medicaid program as it ensures the efficient use of resources, prevents overutilization, promotes equity in resource distribution, mitigates fraud and abuse, contributes to program longevity and ultimately enhances healthcare access for beneficiaries.
Employee assistance programs have become essential tools for organizations aiming to address mental health challenges, reduce burnout and foster healthier workplaces.
Emblem Health’ s chief financial officer knows that prior authorization — where patients have to get advance clearance for a procedure from their insurance companies through their providers — can be frustrating. But in an interview at the Total Health conference organized by Reuters Events in Chicago on Thursday, she rejected the notion that the […]
Seniors’ demand for Medicare Advantage plans shows no signs of slowing down any time soon, and that means CMS is likely to continue accelerating its FWA audits of MA plans, particularly given the prevalence of Covid-19-related fraud.
Although telehealth offers many benefits for patients, it introduces operational complexities for providers and creates legitimate concerns about fraud, waste and abuse for payers.
A new study evaluating waste in the U.S. healthcare system identified six areas of wasteful spending and how cost curtailment efforts are ongoing there.
Choosing the right brain injury rehabilitation program is a critical decision that can shape the future for you or your loved one.