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can healthcare fraud special investigators keep up the pace?

This week the U.S. Justice Department announced one of the biggest multi-agency healthcare fraud busts in history involv...

NCQA’s new timeline is out—are you ready for HEDIS® 2018?

Quality reporting is closely aligned with financial success for health plans across the country, amplifying the importan...

amid healthcare reform, ACA risk stabilization goes on

While the House and Senate attempt to re-write healthcare policy, the pressing problems that the Affordable Care Act (AC...

who canceled summer? why the HEDIS® 2018 season really starts now

Ah, summer. Time to relax, pat yourself on the back for a job well done for HEDIS® 2017, and think about something else ...

step up your game: how to improve risk adjustment coding accuracy

The Office of Inspector General (OIG) sets the bar for coding accuracy at 95 percent, but you can’t achieve that goal wi...

podcast: why value-based care requires “strength from all sides”

As the transition from fee-for-service to value-based care continues to disrupt the healthcare industry, payers and prov...

when waste becomes fraud: where do you draw the line?

Under HIPAA, healthcare fraud is defined as “knowingly, and willfully executing or attempting to execute a scheme … to d...

from the HEDIS® 2017 trenches: the final countdown

As HEDIS® season comes to an end, you always seem to have an infinite number of things to remember to ensure your submis...

busted: the top fraud and abuse busts in Q1 2017

Tens of billions of dollars are wasted each year thanks to fraudulent healthcare billing practices, according to the Nat...

from the HEDIS® 2017 trenches: for MRRV success, don’t overlook over-reading

Now that we have a second season with the new medical record review validation (MRRV) guidelines under our belts, were y...

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