Category Archives: iMAX Medical Billing Insights

4 Medical Billing Issues Affecting Healthcare Revenue Cycle

Addressing these four common medical billing challenges can have a positive impact on the healthcare revenue cycle. Medical billing is the backbone of healthcare revenue cycle management, but many providers experience significant challenges with efficiently and accurately billing patients and payers for services they perform. The medical billing process can be a pain point for some providers because it involves an array of healthcare stakeholders and each step to getting paid relies on the previous interaction. Healthcare organizations must communicate across departments and payers as well as ensure that crucial information is properly captured in each step of the process. Despite the

Physician Shortage Drives Boost in Nursing, Physician Assistant Pay

Recent research shows compensation for nursing staff, physician assistants, and non-clinical employees is rising as provider organizations tackle the physician shortage issue. As the physician shortage worsens, provider organizations are increasingly relying on non-physician providers to fill the gap. And they are paying nursing staff, physician assistants, and other employees more to make up for it. The healthcare industry is facing a significant physician shortage, the Association of American Medical Colleges (AAMC) recently reported. The organization estimated a shortfall of up to 121,300 physicians by 2030 as the aging population seeks additional healthcare services and aging doctors retire. With substantial physician

Over 600 Individuals Charged in 2018 Healthcare Fraud Takedown

In the largest healthcare fraud takedown to date, OIG and DoJ reported charging individuals involved in fraud schemes that cost Medicaid and Medicare $2 billion. The HHS Office of the Inspector General (OIG) and Department of Justice (DoJ) recently announced the largest healthcare fraud takedown to date, with over 600 defendants charged with participating in fraud schemes amounting to about $2 billion in losses to Medicare and Medicaid. Of the over 600 defendants charged, 165 were medical professionals, including 32 doctors who allegedly participated in healthcare fraud schemes involving prescribing and distributing opioids and other narcotics. The charges jointly announced by the

Avoiding the Wide Net of Fraud Conspiracy Investigation

Protecting your company from a potential exposure, whether on the civil or criminal end, from the outside or from insiders, requires dedication to compliance. The word is out. There is money to be made in healthcare fraud—and not just in schemes by providers to steal payor funds, but by the government under federal and state statutes busting fraudulent conduct. How an action starts is really quite simple: maybe a former patient or employee reports a provider, or maybe a provider is just such a high utilizer of services that the conduct is brought to the attention of an oversight agency.

‘Incredible loss of life’ to overdoses

Over seven years, Hancock County lost nearly 2,000 years of life expectancy because of opioid overdoses, and Ohio lost more than half a million years. Those figures are among the findings of a recent report by the Ohio Alliance for Innovation in Population Health, a collaboration between Ohio University’s College of Health Sciences and Professions and the University of Toledo’s College of Health and Human Services. Statewide, 13,059 Ohioans died from opioid overdoses from 2010 to 2016, and those overdoses accounted for 519,471 years of life lost. “This figure represents over half a million years of life lost to Ohioans

How can we build social support for people in recovery?

When we asked Ohioans to share what they saw as causes of the addiction crisis, many cited boredom, lack of activities, and peer pressure. Even after undergoing treatment for substance use disorder, people face the possibility of falling back into the same toxic routine and friendships they had before seeking help. According to the Substance Abuse and Mental Health Services Administration, recovery will be most successful if people have a safe, comfortable, and secure home, meaningful activities to do such as working, going to school, and volunteering, and a strong community of people that offer encouragement along their journey. On

Lorain Drug Rehab Facility Expanding Due To Ohio Medicaid Reorganization

With demand for drug treatment soaring due to the opioid epidemic, addiction service providers are looking for ways to get people who want help off waiting lists and into their facilities. For years, the federal Centers for Medicare and Medicaid Services (CMS) – the agency that pays the bills for many people in rehab – has prohibited the use of federal dollars for addiction treatment in facilities with more than16 beds. Ideastream’s Be Well health reporter Marlene Harris-Taylor and ideas host Rick Jackson had a conversation about how things are changing around the 16-bed rule specifically for rehab facilities in

Fentanyl use drove drug overdose deaths to a record high in 2017, CDC estimates

Drug overdose deaths surpassed 72,000 in 2017, according to provisional estimates recently released by the Centers for Disease Control and Prevention. That represents an increase of more than 6,000 deaths, or 9.5 percent, over the estimate for the previous 12-month period. That staggering sum works out to about 200 drug overdose deaths every single day, or one every eight minutes. The increase was driven primarily by a continued surge in deaths involving synthetic opioids, a category that includes fentanyl. There were nearly 30,000 deaths involving those drugs in 2017, according to the preliminary data, an increase of more than 9,000 over the

Cheaper, purer meth piggybacks opioid crisis in Ohio

PIKETON, Ohio – Richard Kreager is quick to share his most embarrassing photos: The one where he is handcuffed on the side of the road, surrounded by police officers, or the shot of him lying in a hospital bed, hooked to a ventilator, his kidneys shutting down. Each, he says, serves as a cautionary tale of his addiction to methamphetamine. “They say one time is too many, and 10,000 times are never enough,” said Kreager, 35, of Dublin, who has been in a southern Ohio recovery program since the spring. “It’s just as bad as heroin.” In Ohio, the number

Healthcare Claims Management Market to Reach $13.9B by 2023

Increasing patient volumes and declining reimbursement rates will drive providers and payers to seek healthcare claims management solutions by 2023. The global healthcare claims management market is slated to reach $13.93 billion by 2023, up from a valuation of $10.16 billion in 2017, MarketsandMarkets recently reported. The significant projected growth in the healthcare claims management market equates to a 5.3 percent compound annual growth rate (CAGR) during the forecast period. “The key factors driving the growth of this market are increasing patient volumes, expanding health insurance market, growing importance of denials management, and declining reimbursement rates,” explained the market research organization.