News & Analysis

July 10, 2019
News & Insights

Accountable care organizations (ACO) avoid downside risk contracts even though the number of ACO contracts and ACOs with multiple contracts have grown, according to a recent study. The study authors suggest that stronger incentives to take on downside risk are necessary to ensure the success of the ACO model.

July 8, 2019
News & Insights

Q: What are Medicare's criteria for reopening a claim as opposed to treating it as a denial?

July 3, 2019
Medicare Insider

This week’s Medicare updates include a policy clarification regarding negative wound therapy, an executive order on price transparency, and more! 

July 3, 2019
News & Insights

Anne Arundel Medical Center in Annapolis, Maryland, will pay $3,154,000 to settle allegations that it submitted false claims to Medicare for medically unnecessary evaluation and management services and separately billing bundled procedures

July 1, 2019
Briefings on APCs

ED physicians commonly treat fractures. A fracture can be the result of a traumatic injury, such as a fall, or may be pathologic (i.e., due to a disease process). In general, fractures can be classified as open or closed, displaced or nondisplaced.

July 1, 2019
Briefings on APCs

In 2013, “Guidelines for Achieving a Compliant Query Practice,” a collaboration between AHIMA and ACDIS, was published. It has served as the industry guideline for the establishment of best practices surrounding queries. The 2019 update reinforces the information set forth in the preceding practice briefs while also introducing some newer guidelines reflective of today’s healthcare environment.

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