Payers


Health insurance plans serve as the financial backbone of health care, functioning as the crucial link between employers and providers in the $2.5 trillion industry. Topics include: claims management systems, quality improvement programs and claims processing standards.


HDM to Host Health Analytics Event in July

Feb 22
Health Data Management is hosting the Healthcare Analytics Symposium & Expo, July 24-25 at the Hyatt McCormick Place in Chicago.
Chronic Care
Data Repositories
EHR
Group Practices
Hospitals

HIMSS12 Notable and Quotable

Gary Baldwin | Feb 21
“Anyone who claims to be an accountable care organization expert is just blowing smoke,” Gary Austin, president, TranzformHealth, in opening the ACO symposium, explained how the model is too new for anyone to claim expertise.
Group Practices
Hospitals
Policy & Regulation

Aetna CEO: Health Insurers Face Extinction

Bill Kenealy | Feb 21
It’s not often that you hear the leader of Fortune 100 company publicly acknowledge the imminent demise of his venerable, profitable business model.
EHR
Consumer Health
Chronic Care
Policy & Regulation

Dave Garets: Hospitals Way Short of ACO I.T. Needs

Gary Baldwin | Feb 20
The majority of hospitals fall considerably short when it comes to having the I.T. needed to succeed as an accountable care organization.
Policy & Regulation
Hospitals
Group Practices
EHR

HHS Intends to Delay ICD-10 for ‘Certain Health Care Entities’

Joseph Goedert | Feb 16
The Department of Health and Human Services on Feb. 16 issued a statement announcing its intent to push back the Oct. 1, 2013, compliance deadline for ICD-10 “for certain health care entities.”
Comments (1)
Coding
EHR
Electronic Data Interchange
Revenue Cycle Management
Group Practices
Hospitals
Policy & Regulation

Is Stage 2 Meaningful Use Out on Feb. 17?

Joseph Goedert | Feb 16
There are indications that the proposed rules for Stage 2 of the electronic health records meaningful use program will come out on Feb. 17, a few days before the giant HIMSS Conference in Las Vegas.
EHR
Group Practices
Hospitals
Policy & Regulation
Stimulus

New Standards Support Patient Data Exchange

Joseph Goedert | Feb 15
Standards development organizations OMG and Health Level Seven International have announced availability of the hData Record Format and hData RESTful Transport specifications for electronically exchanging patient information.
Health Info Exchange
Group Practices
Hospitals
EHR
Decision Support

CMS Clarification on ICD-10 Stance Coming Soon

Joseph Goedert | Feb 14
The Centers for Medicare and Medicaid Services expects soon to clarify a new commitment to re-examine implementation of the ICD-10 code sets.
Coding
EHR
Revenue Cycle Management
Policy & Regulation
Group Practices
Hospitals

ONC Project Query Health Starts Testing its Analytics Standards

Feb 14
The Office of the National Coordinator for HIT in September 2011 launched Query Health, an initiative to establish standards and services for distributed population health queries. Now, two Query Health leaders, Michael Buck and Rich Elmore, have written a column explaining the effort and its first pilot program in New York.
Data Repositories
Decision Support
EHR
Hospitals
Group Practices
Policy & Regulation

Correction: OCR HIPAA Rule Scheduled for March

Joseph Goedert | Feb 14
Health Data Management on Feb. 13 erroneously reported that the expected final rule covering the HIPAA privacy, security, breach notification and enforcement rules was not in the Department of Health and Human Services’ new semi-annual regulatory agenda listing forthcoming regulations.
EHR
Data Security
Consumer Health
Health Info Exchange
Group Practices
Hospitals
Stimulus
Policy & Regulation

Insurers and Vendor Lumeris to Acquire NaviNet

Joseph Goedert | Feb 14
With the goal of serving accountable care organizations, three Northeast Blues plans and a data aggregation/analysis vendor will acquire NaviNet Inc., a health care transactions processing vendor. Terms of the acquisition, expected to close within 30 days, were not disclosed.
Electronic Data Interchange
Health Info Exchange
Policy & Regulation
Revenue Cycle Management
Disease Management
Vendor News
Decision Support
Hospitals
Group Practices
EHR

CMS Beefs up Its EHR Incentive Programs Site

Joseph Goedert | Feb 14
The Centers for Medicare and Medicaid Services’ EHR Incentive Programs Web site has a new page with information on the clinical quality measures within the meaningful use program.
EHR
Group Practices
Hospitals
Policy & Regulation
Stimulus
Revenue Cycle Management

The State of Cloud Standards

Justin Kern | Feb 10
As cloud computing adoption rates soar, standards groups see promise with establishing aligned interfaces, rules written into RFPs and SLAs, and harmonized government legislation.
Web Technology
Hospitals
EHR
Health Info Exchange
Group Practices

Fairly Shocking: The Feds as an Efficiency Leader?

Greg Gillespie | Feb 10
My father wasn’t the first or last to say that it will be a sad day indeed if the private sector ever gets lapped by the feds in terms of efficiency.
Coding
Group Practices
Revenue Cycle Management
Revenue Cycle & Payments
Mobile Technology
Practice Management
Electronic Data Interchange
Policy & Regulation

Docs to Get $200 Million in Settlement for Underpaid Claims

Joseph Goedert | Feb 09
In 2009, UnitedHealth Group agreed to settle for $350 million a lawsuit the American Medical Association filed charging the insurer with underpaying for out-of-network services. Now, a federal judge has issued rulings to release $200 million to settle claims that physicians filed against UnitedHealth.
Comments (1)
Group Practices
Revenue Cycle Management
Policy & Regulation
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