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A medical biller then takes the coded information, combined with the patient's insurance details, and forms a claim that is submitted to the payors. [2] Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4]
In the Washington, D.C. metropolitan area, plans open to all federal employees and annuitants include 10 fee-for-service and PPO plans, seven HMOs, and eight high-deductible and consumer-driven plans. [4] In the FEHB program the federal government sets minimal standards that, if met by an insurance company, allows it to participate in the program.
The House sued the administration, alleging that the money for CSRs to insurers had not been appropriated, as required for any federal government spending. The ACA subsidy that helps customers pay premiums was not part of the suit. Without the CSRs, the government estimated that premiums would increase by 20% to 30% for silver plans. [417]
Humana has agreed to pay $90 million to the federal government to settle a whistleblower lawsuit under the False Claims Acts.. The lawsuit, filed by Phillips & Cohen LLP on behalf of whistleblower ...
The primary purpose of the ACA was to increase coverage to the American people either through public or private insurance and control healthcare costs. The Congressional Budget Office (CBO) estimated that the ACA would reduce the number of uninsured by 32 million, increasing coverage for the non-elderly citizens from 83 to 94 percent.
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Last week, Humana Inc (NYSE:HUM) agreed to pay $90 million to the federal government to settle a whistleblower lawsuit alleging fraudulent Medicare Part D bids. The lawsuit, filed by Phillips ...
The discussions came six years after regulators blocked mega-deals that would have consolidated the U.S. health insurance sector. Cigna, however, on Sunday announced plans to do an additional $10 ...