decisionhealth Newsletters, Part B News - 2000 Issue 7 (July)
HCFA renegotiating contract with McKessonHBOC
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Article Overview
This article covers HCFA’s contract discussions with McKessonHBOC regarding a proprietary claims-editing system used in Medicare coding review. It explains the broader policy debate around secrecy versus disclosure, the role of AMA review, and the reactions of physicians, lawmakers, and Medicare oversight groups. The article is relevant to professionals tracking Medicare payment integrity policy, CPT-related claim editing, and administrative contracting issues.
Why This Topic Matters
It helps readers understand how proprietary coding edits affected Medicare claims processing, why disclosure of edit logic became controversial, and how federal policy, vendor contracts, and physician groups shaped the discussion.
What You Will Learn
- The policy context behind proprietary Medicare coding edits
- How HCFA and its contractor were discussing continuation of an editing system
- Why confidentiality and disclosure were contentious issues
- How physician groups and oversight organizations responded to the program
- The broader fraud and abuse rationale associated with claims editing
Who Should Read This
- Medical coders
- Billing professionals
- Compliance staff
- Health care attorneys
- Practice managers
- Policy analysts
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