Incentives matter. Fun fact: It’s hard for a hospital to lose money. Health care spending in the U.S. just keeps going up and up, people are getting older, and medical bills aren’t getting any cheaper. If a hospital is losing money, something is going wrong. The typical response…
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The United States of Licensing In this, the land of freedom and opportunity, we sure do love slapping licenses on just about anything, don’t we? Want to braid someone’s hair? Better get 300 hours of cosmetology training—because you never know when an innocent braid might turn into a…
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The accuracy of lab testing. The basic assumption when taking a test is that the test should give credit for giving the correct answer. If the question is what is 2+2 and you respond 4, you should get credit. If the test gives credit for answering “63,” then…
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I need this job, but… We’ve all been in the position of applying for a job that we want but is just not quite right fit for our resume. You have 8 out of the 10 required skills. And you can fudge the others. You can stretch some…
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What are concurrent surgeries? Concurrent surgeries, also known as “double-booked” or “simultaneous” surgeries, occur when a surgeon is scheduled to perform more than one operation at the same time. In these cases, the surgeon might start one procedure, leave to begin or assist in another surgery, and then…
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What is the Universal Service Fund? The United Nations considers access to the internet to be a human right. The United States has taken steps to ensure that everyone, regardless of geography has access to the internet. It’s easy to provide broadband access in cities because of the…
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What is RUG score? A RUG (Resource Utilization Group) score in Medicare is used to determine the amount of reimbursement a facility receives for providing care to patients in skilled nursing facilities (SNFs). The score is calculated based on the level of care and resources required by the…
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What is upcoding? In the healthcare industry, billing codes are utilized to charge Medicare or Medicaid for patient services, with each code representing a specific procedure or diagnosis. These codes are used by the government to calculate reimbursement amounts. Upcoding happens when a healthcare provider submits a bill…
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Missed Opportunity: How a $50 Billion Medicare Fraud Shows the Need for Vigilant Whistleblowers Recent investigations have revealed a staggering $50 billion fraud perpetrated by insurers who exploited the Medicare Advantage program by inflating patient diagnoses. This fraud, which allowed insurers to collect payments for diseases that were…
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Cost plus percentage of cost contracts violate the False Claims Act. Let’s say you need to remodel your house. You interview a few contractors, decide on a plan, and then get to the really important part: how to pay for it. There are all sorts of ways to…
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