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.
Talent recruitment and retention is a growing challenge for healthcare organizations around the world because of lower overall birthrate, leading to fewer potential workers, and Baby Boomers reaching retirement.
Providers have ideas for software vendors and regulators on how to make the next stage of meaningful use a bit more realistic.
Small physician practices using telemedicine can make quality care more accessible to patients in underserved communities, but numerous barriers are preventing the technology from realizing its potential, according to a July 31 congressional hearing.
Four months after President Obama signed into law a one-year delay in the ICD-10 code switchover, the Centers for Medicare and Medicaid Services has announced a final rule establishing October 1, 2015, as the new ICD-10 compliance date.
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.