The Resurgence of RAC Audits

The RAC program began in 2009 with the goal of recouping Medicare payments considered to be “wasteful” or “fraudulent.” While the program has recouped more than $8 billion since its inception1, it puts a heavy financial burden on providers as it generates administrative costs for coordinating requests and legal fees for appealing results if providers [...]

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Top 10 List – Physician Risk Mitigation for Government Audits

By Carla Engle, MBA, product management expert, large physician groups and hospitals, TriZetto Provider Solutions  In February, the Centers for Medicare & Medicaid Services (“CMS”) announced that no additional Recovery Audit Contractor (“RAC”) reviews would be conducted with the current contractors, and the program has been on hold since June. However, CMS announced in August that [...]

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TriZetto Provider Solutions Announcement – Cognizant to acquire TriZetto

This morning, Cognizant has announced a definitive agreement to acquire TriZetto Corporation, including the TriZetto Provider Solutions business unit (formerly Gateway EDI, NHXS, and ClaimLogic). We believe this is a positive opportunity for both companies, and that it will provide numerous benefits to our clients. Click here to read the press release.

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The Deadline is Set: The ICD-10 Transition Will Occur on Oct. 1, 2015

The Department of Health and Human Services (HHS) announced that October 1, 2015, will be the compliance deadline for ICD-10. This means that providers have just 13 months to prepare for the transition. The Centers for Medicare and Medicaid Services (CMS) is helping providers prepare for ICD-10 by testing their ICD-10-coded claims. Beginning in November [...]

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Webinar: 60 Days of Uncertainty – Understanding the Affordable Care Act’s 90-Day Grace Period

We are sorry you missed TriZetto Provider Solutions’ August 20th webinar ” 60 days of uncertainty: Understanding the Affordable Care Act 90 Day Grace Period”. Catch the replay of the webinar, ” 60 days of uncertainty: Understanding the Affordable Care Act 90 Day Grace Period”. To learn what you can do to improve your collections [...]

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