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Artificial intelligence (AI) is everywhere, even when you don’t ask for it. When you do a search with Google, it now provides not only webpages but also an AI summary of what it thinks I am trying to figure out. And I will admit that I am still very wary of AI, but possibly because I have been avoiding learning to use it optimally.
Then, last week I got a question a...
It is very easy to get confused about what is and is not protected by the attorney client privilege. If it feels like I have been a bit obsessed with privilege as of late it’s because I have been. Privilege questions have played an outsized role in cases recent investigations.
Here is a real-world example of how complicated these questions can be. At a meeting w...
A federal court ruling is set to change how health plans calculate a key payment benchmark under the No Surprises Act (NSA), with implications for insurers, providers, and the law’s dispute resolution process.
Last week, the US Court of Appeals for the Fifth Circuit issued its long-awaited decision in a case called “TMA III,” following a rehearing by the full court ...
There are several proposed reform options in Congress that could make changes to the 340B drug pricing program.
There are a few different bills pending in Congress that would make significant changes to 340B. I won’t cover them all today, but I’ve been getting questions about which proposals are most likely to become law. First, I’ll note that there isn’t much time ...
Artificial intelligence companies developing healthcare revenue-cycle tools need large volumes of real claims data. Two of the most valuable sources are the 837 electronic claim and the 835 electronic remittance advice.
The 837 reports what the provider billed. The 835 reports how the payer adjudicated that claim, including payments, denials, adjustments, deductible...