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.
A data analysis reveals that expenses for deductibles and other out-of-pocket costs are changing inconsistently among the four categories of Accountable Care Act plans.
UnitedHealthcare's free mobile app Health4Me is now available to all consumers. The app gives users access to an array of healthcare information, including the ability to review market average prices for more than 520 medical services.
Two court rulings issued this week taking opposing views on the legality of subsidies granted to individuals who enroll in the public healthcare exchanges have the potential to further delay the employer mandate, say some legal experts.
The Electronic Healthcare Network Accreditation Commission, which certifies entities that process transactions or exchange health information for meeting best practices, is launching new programs to accredit accountable care organizations and physician practice management systems.
Major shifts are taking place in the health care market which will lead to disruptive and constantly-moving changes, including private exchanges. Those that realize the change ahead and adapt to it will be the ones that are successful.
The announcement that IBM and Apple have partnered to bring Big Data analytics to Apple mobile device users in enterprise business settings is getting a cautiously positive reaction from healthcare stakeholders.
When Aetna starts work with delivery systems to form accountable care organizations, the insurer typically analyzes claims data to get a picture of a providers present status and guide creation of an efficiency model.
Though analytics can be descriptive and predictive, today most healthcare organizations are users of descriptive analytics, leveraging reporting tools and applications to understand what has already happened in the past to classify and categorize historical data.
Concerns that nationwide electronic health record adoption could lead to widespread fraudulent coding and billing practices that result in higher healthcare spending are unfounded, according to a study from the University of Michigan School of Information and the Harvard School of Public Health.
Analysis of data on ambulatory providers satisfaction with their claims clearinghouses finds many are generally pleased with their vendors performance.
Among the multitude of tasks to prepare for the ICD-10 code sets, providers also should conduct two core tests with insurers: Acknowledgement testing, also known as historical validation testing, and End-to-End testing.
Ten eligible hospitals and 972 eligible professionals have attested to Stage 2 meaningful use as of July 1, according to the latest numbers from the government.
The Centers for Medicare and Medicaid Services has certified the Health Care Cost Institute as the first national "Qualified Entity" to have full access to national Medicare claims data for reporting on the costs and quality of healthcare services.
"Patient engagement" is a popular term currently, but the practice of providing consumers with relevant data about the clinical and financial aspects of their care is still in its infancy. Nevertheless, employers and health plans appear to be more than ready to provide such platforms to consumers.
Analyses of biomedical data from nearly 37,000 volunteer employees of a large company insured under Aetna shows a success rate of 80 percent to 88 percent in predicting risk of metabolic syndrome, which can cause chronic disease.