It's no secret that health insurance claim errors resulting in hundreds of millions of dollars in overpayments are common for large health plans. However, when the health plan is providing administrative services only (ASO) for self-funded plans, the incentive to recover overpayments decreases for a number of reasons.
Washington, D.C. - Several Congressional leaders, the Bush administration and major players in the e-health community are promoting electronic prescribing systems as an achievable step toward broader health information interconnectivity. Legislation to postpone a cut in Medicare payments to physicians includes a provision that encourages electronic prescribing by physicians.
The administration of Illinois Governor Rod Blagojevich (D) has hidden its state budget problems by rolling over an average of $1.5 billion in Medicaid claims each year since 2005.
National Reports - A new Ohio mandate standardizes the credentialing process and promotes more contracting transparency and fairness in the managed care process.
Washington, D.C. - Government agencies and qualified researchers will be able to tap into Medicare Part D claims data to learn more about drug coverage and safety under a new policy issued by the Centers for Medicare and Medicaid Services (CMS).
Drug trend for 2007 was 2%, the lowest year-over-year trend since Medco began tracking it in 1999, according to the company. While the drug cost trend is small in terms of overall healthcare dollars spent, it was at one time rising at a rate more than double the rate of inflation, according to Lon Castle, MD, senior director, department of medical and analytical affairs at Medco.
Starting March 28, data on patient experiences in the hospital was added to the federal government's Hospital Compare Web site. Patients' feedback was drawn from a 27-question survey developed by the Agency for Healthcare Research and Quality (AHRQ), and reflects the issues of greatest concern to patients. Data about patients' experiences in 2,500 hospitals has already been uploaded to the site; by the end of the year, information from most of the nation's hospitals will be available.
According to results of Deloitte Consulting's 2008 Survey of Health Care Consumers, nearly 80% of consumers want their physicians to provide online access to medical records and test results. Thus, the cry has gone out for physicians, providers and purchasers to respond quickly. In the travel and banking industries, data moves freely between applications-and that's the current challenge for the healthcare industry.
Statin medications lower cholesterol levels and have an anti-inflammatory effect. They should be used in combination with lifestyle changes to reduce heart disease risk.
Methicillin-resistant Staphylococcus aureus (MRSA), a type of bacterium that is resistant to certain antibiotics, has become a national epidemic, with increasing numbers of serious infections, hospitalizations and deaths. Hospital stays for these infections tripled from 2000 to 2005.
While legislators and healthcare stakeholders across the country wrangle over the problem of the nation's 46.5 million uninsured, a grassroots movement called Project Access is having an impact on the health of thousands of uninsured Americans.
Your advertising campaign has officially become old-school. That stock image of pleasant patients and attractive doctors? You aren't catching anyone's attention with that approach anymore. Meet HealthPartners' new mascot: Petey P. Cup. Yes, that's right, a urine specimen cup is a walking, dancing, huggable mascot that makes appearances at clinics, health fairs and events around the Twin Cities. Petey also has a syringe sidekick named Pokey.
Genetic testing is used to predict or diagnose a disease for an individual. It also makes possible the use of pharmacogenetics-the study of genetic variation that translates to differing response to drugs-to align drug treatment for maximum effectiveness. The emerging field of pharmacogenetics has opened up a new world of personalized treatment and evidence-based medicine.
When Peter Lee stepped down in January from his eight-year tenure as president and CEO of the Pacific Business Group on Health (PBGH), he chose to stay close to home, taking over the new role of executive director of national health policy for this non-profit organization of large employers and other major purchasers. Although Lee wears a new hat, he is confident that he has left the CEO position in the hands of a competent and experienced healthcare thought leader: David Lansky. The duo has easily blended its expertise-Lansky as the information technology whiz and Lee as the national healthcare policy guru and patient advocate. Both share a passion for data and measurement.
Capitation and other risk-sharing arrangements have been pursued by provider organizations for the past two decades. Yet the law on whether such arrangements result in the provider organization being in the business of insurance has not fully evolved in all states.
Regardless of an insurer's composition - public or private, large or small, geographically diverse or regionally focused - reducing non-labor general and administrative (G&A) expenses can contribute greatly to margin improvement.
The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to expand the recommended ages for annual influenza vaccination to include all children from 6 months through 18 years of age.
The purpose of the attorney-client privilege is to encourage frank communications between attorneys and clients, which promotes dissemination of sound legal advice. Regarding the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), some courts have found that an ERISA plan fiduciary may not assert the attorney-client privilege against plan participants regarding matters of plan administration.
An investigational first-in-class dual angiotensin and endothelin receptor antagonist lowered systolic blood pressure (SBP) in patients with stage 1 and 2 hypertension in a phase 2a trial, reported Joel M. Neutel, MD, associate professor of medicine, University of California, Irvine, and medical director of clinical pharmacology, Orange County Research Center, Tustin, California. These results were presented at the 23rd Annual Scientific Meeting of the American Society of Hypertension, New Orleans, May 14–17, 2008.
The combination of amlodipine and olmesartan was demonstrated to be superior to monotherapy with either agent in difficult-to-treat hypertensive populations in a subgroup analysis of the registrational trial for this combination therapy. These results were presented at the 23rd Annual Scientific Meeting of the American Society of Hypertension, New Orleans, May 14–17, 2008.
The number of major employers offering employee wellness programs with incentives grew over the past year, according to a study presented by Health2 Resources. The National Association of Manufacturers and The ERISA Industry Committee participated in the survey.
The National Committee for Quality Assurance’s (NCQA’s) proposed standards and measures for a new Wellness and Health Promotion (WHP) product evaluation have been released for public comment.
Access to coverage, especially for individuals and small groups, is a constant issue. So much so that many Americans are taking great steps to change their lifestyles in order to obtain it. Get married to gain access to insurance? Some are doing just that.
U.S. drug regulators are said to be close to allowing doctors to e-prescribe addictive medications, including painkillers. According to Reuters, the Drug Enforcement Administration is expected to publish a proposal on e-prescribing controlled substances.
Two votes from Republican senators killed a House bill that would have averted statutory payment reductions for Medicare physicians, just before legislators left Capitol Hill for their Independence Day holiday. Medicare physicians now face 10.6% fee cuts, but there is an opportunity for retrospective increases after the recess.
The risk of fracture is probably only slightly increased in persons with type 2 diabetes, said Peter Vestergaard, MD, PhD, DrMedSc, from the Osteoporosis Clinic, Aarhus Amtssygehus, Denmark.
Real-time continuous glucose monitoring (CGM) can significantly improve glycemic control, but it will not help all patients. "Real-time CGM will add significantly to glucose management for some people, but not for all," said Irl Hirsch, MD, University of Washington, Seattle. "Human factors make all the difference between success and failure. Some patients will never figure it out. That?s why real-time control is so challenging.
Good glycemic control is not sufficient to relieve painful diabetic neuropathy, necessitating investigation of other modalities to achieve analgesic efficacy. Dan Ziegler, MD, German Diabetes Clinic, German Diabetes Center, and professor of internal medicine, Leibniz Institute at the Heinrich Heine University, Düsseldorf, provided an overview of pharmacologic treatments that have been explored for painful diabetic neuropathy and the success achieved with each.
Clinicians and type 2 diabetes patients have a new worry: hepatic steatosis, or nonalcoholic fatty liver disease. Liver disease is a less-obvious problem than kidney disease but may have equally grave consequences.
Healthcare reform is a high-profile issue in the presidential election campaign, and drug access has become a central theme in the debate. Both Democratic and Republican candidates have rolled out healthcare reform plans that promise to cover the uninsured while also providing tax breaks and other incentives to help individuals obtain health insurance.
