Because of a rising number of risk adjustment audits and changes in HEDIS (Healthcare Effectiveness Data and Information Set) rules, providers should prepare for audit volumes to practically double in 2016. In fact, the National Committee for Quality Assurance (NCQA) estimates 2.5 million requests from HEDIS alone and another 6.5 million from health plans in the health information exchange market.
The clinician called a prospective customer who was applying for health insurance to pose a very direct question: Why had she left the names of several medications she was taking off the application she submitted to Aetna? The clinician rattled off the names of the drugs, the dates they were prescribed, and the doctors who had prescribed them.
Should Anthem and Cigna manage to accomplish their proposed $48 billion merger, senior IT management will have plenty to do, and headcount and budgets likely would increase, at least in the short term, according to industry experts.
The National Committee for Quality Assurance has introduced a free mobile app enabling consumers to search for physicians and insurers that have received NCQA accreditation for meeting a range of specific quality standards.
Young adults just entering the market for health insurance on HealthCare.gov and state-operated insurance exchanges are not receiving the kind of education they need to make informed choices, according to research conducted by clinicians at the University of Pennsylvania.
The Supreme Court ruled in King v. Burwell that subsidies used to purchase health insurance in the 36 states on the federally facilitated marketplace are legal, thus avoiding the death spiral so often referred to by Congress. What does this ruling mean for employers?