Andria Jacobs, RN, MS, CEN, CPHQ
Ms Jacobs is the chief operating officer for PCG Software and has more than 25 years' experience in the healthcare industry, encompassing both administrative and clinical arenas. Prior to joining PCG, Ms Jacobs was the administrative director, medical management for VertiHealth Administrators. Previously, she was an independent consultant in ambulatory care and practice management, where her clients have included hospitals, physician groups, and the University of California, Los Angeles.
October 20, 2017
The American Medical Association and more than 650 other organizations support eliminating the Independent Payment Advisory Board, set up as part of Obamacare. The writer supports this position, based on her professional experience, which includes the case of a young woman dying of tuberculosis (TB).
August 20, 2017
The federal government levies hefty fines for breaches but doesn't have to follow its own rules.
May 14, 2017
While it remains to be seen how the Trump administration deals with healthcare fraud, preventing fraudulent practices within your organization should be a priority-unless you want to be held personally liable.
April 17, 2017
While the Merit-based Incentive Payment System (MIPS) has gone into effect for physicians that participate in Medicare Part B, many questions remain about the practicalities of the program. Physicians could also participate in advanced alternative payment models (APMs), but the vast majority of physicians and physician groups are expected to participate in MIPS.
March 22, 2017
Despite increased regulations and millions in drug distributor and pharmacy fines, opioid addiction continues to kill more than 33,000 people in the US each year. Opioid overdoses have quadrupled since 1999, according to the CDC. Payers and providers should be doing their parts to stem this tragic epidemic by examining claims data more closely.
November 03, 2016
No matter who is elected president, the exchanges created by the Affordable Care Act are in need of a fix.
April 16, 2016
Drug prices are rising faster than any other area of healthcare, but solutions aren't so simple. Easing barriers to competition, promoting approval of generic drugs, and increased transparency would help.
March 11, 2016
The United States loses approximately $100 billion to healthcare fraud annually. Up to $20 billion dollars are due to fraudulent practices in the mental health sector. One of the largest healthcare fraud cases in US history occurred in behavioral health -- one of healthcare’s smallest sectors.
February 04, 2016
One of the primary drivers of healthcare waste is administrative inefficiency. While the industry implements remedies and solutions with electronic prescriptions and electronic claims transfer and processing, the gorilla in the room that no one mentions is CMS.
November 06, 2015
Our homes should be sanctuaries-places of refuge and safety-but sadly, fraud is alive and thriving in home healthcare, endangering one of our most fragile and vulnerable patient populations: the homebound and often bed-bound. Defenseless people who may be totally alone, without family or friends.
September 18, 2015
The number of nurse practitioners (NPs) in the United States has doubled in the last decade, from 106,000 in 2004 to 205,000 in 2014, according to the American Academy of Nurse Practitioners. Similarly, the number of physician assistants (PAs) grew 219% from 2003 to 2013, according to the National Commission on Certification of Physician Assistants.
August 11, 2015
Medicare and Medicaid billing fraud scams-upcoding and unbundling schemes, double and triple billing, phantom billing and illegal kickback schemes -cost the United States an estimated $100 billion annually, inflating the size of government, escalating healthcare costs and burdening taxpayers.
July 03, 2015
As co-pays and deductibles in Medicare and commercial health plans become more prevalent, so, too, does the temptation to waive them. But beware.
May 26, 2015
On January 1, 2015, the Centers for Medicare & Medicaid Service (CMS) introduced 4 Healthcare Common Procedure Coding System modifiers, known collectively as the - X(EPSU) modifiers, as a subset of Current Procedural Terminology (CPT) modifier 59 (distinct procedural service).
May 07, 2015
Designed to improve physician payment, the Medicare Access and CHIP Reauthorization Act of 2015 is a step in the right direction, and certainly better than the alternative, but it's not magic and it's not enough.