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.
Clinical and healthcare financial professionals dont talk to each other and need to, according to Atul Gawande, M.D., a surgeon at Brigham and Womens Hospital, physician IT champion and best-selling author who delivered a June 23 keynote address at the HFMA Annual National Institute in Las Vegas.
A pilot program for the Food and Drug Administrations Sentinel active surveillance system, dubbed Mini-Sentinel, is leveraging electronic healthcare data--principally claims data but also including data from EHRs--to monitor the safety of FDA-regulated medical products.
According to a survey conducted by consulting firm KPMG LLP, healthcare industry managers and executives are expecting profits to be hurt from the introduction of value-based contracting.
Health systems and public sector officials who hope to successfully deploy Medicaid accountable care organizations will have to draw lessons from the Medicare ACO programs underway, yet be flexible in creating the new delivery systems, according to staff analysts from the Center for Strategic Health Studies.
Some health plans and claims clearinghouses are charging excessive fees for paying providers via the HIPAA-mandated electronic funds transfer transaction, or are using virtual credit cards to reimburse for care, according to the Medical Group Management Association.
The California HealthCare Foundation has launched ACA 411, an interactive data tool that supplies policymakers, providers, and other healthcare delivery stakeholders in the state an at-a-glance resource to gauge progress of the Affordable Care Act.
Medicare physician payment data shows that more than 1,000 primary care physicians providing hospital-based services billed Medicare more than five times the average, raising questions about their billing practices.
An initiative to help providers easily enroll to receive electronic funds transfer and electronic remittance advice from insurers got off to a slow start but has gained momentum in recent months.
A Pittsburgh medical nutrition therapy EHR developer spun out of Carnegie Mellon University in 2011 will place its Connect and Coach platform in more than 200 of West Des Moines, Iowa-based Hy-Vee's supermarket stores in eight midwestern states.
Making sense of the tide of health data inundating the U.S. healthcare community remains a daunting challenge for driving clinical and financial performance.
For years, in public opinion polls, people have tended to blame health insurers for premium increases and problems with their coverage. However, Americas Health Insurance Plans, the trade association representing payers providing health benefits for more than 200 million Americans, says it now wants to put consumers at the center of healthcare.
Healthcare is moving rapidly to incorporate measures of value into payment models, with more than two-thirds of payments expected to be based on value measurement in five years, up from just one third today.
Health plans have spent years and millions of dollars acquiring or replacing information systems but a lack of alignment between companies business and IT organizations is hamstringing the industry, according to a June 11 panel at Americas Health Insurance Plans Institute 2014 in Seattle.
At its annual meeting, the American Medical Association approved a list of guiding principles for ensuring the appropriate coverage of and payment for telemedicine services.
Americas Health Insurance Plans, the trade association for payers, is promoting new services to health consumers.