Burden of Healthcare Fraud and Abuse Impacts Everyone
Program integrity strategies focus on pricing and reimbursing the correct amount to legitimate providers and suppliers for covered services — reasonable and necessary services provided…
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Claim Audit Delivers $48,336.27 in Plan Savings
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
Outrageous Anesthesia Charges Raise Questions
As healthcare costs continue to climb an upward slope, there is an escalated and ongoing need for closer assessment of healthcare claims to assist in…
Audit Saves Plan $18,412.58 After Member’s Hospital Stay
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
Time for Change — 2026 Brings New Codes, Guidelines and Medical Billing Considerations
The complexities surrounding medical coding, billing and submitting an accurate claim is a given. Entities in the business of healthcare will attest: keeping up with…
$71,745.06 in Hospital Savings After One-Day Hospital Stay
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
Auditing and Monitoring — A Necessity for Effective Compliance and Ethics
Everyone working in the field of healthcare compliance understands one of the seven key elements of an effective compliance and ethics program is auditing and…
Audit Saves Plan $16,116.80 on Claim
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
Medical Billing Errors on Healthcare Claims — Fraud or Abuse?
In the context of medical coding, fraud involves intentional misrepresentation of services billed. Abuse refers to the falsification of information that was likely an innocent…