When cultures enter Renaissance periods, new learning and ideas create transition. Heightened interest in the workings of pharmacy benefit management and subsequent changes in business philosophy represent a Renaissance for managed care. All key stakeholders will feel the ripples of change: payers, physicians, pharmacists, patients and pharmaceutical companies.
Establishing and managing a RHIO is a little like promoting world peace.
The amount of fraud and abuse in the U.S. healthcare system is staggering and continues to grow at an exorbitant rate. Many factors contribute to this growing incidence of insurance fraud. For example, an ever-increasing volume of transactions, antiquated procedures that were not established to assume that fraudulent claims would be made, and complex and multiple reimbursement methodologies that open insurers to the risk of inappropriate claim payments because of fraudulent and abusive billing practices.
For some insurers, television ads have taken center stage.
Washington--The roll-out of the new Medicare drug benefit and expansion in the Medicare Advantage (MA) program is prompting the Centers for Medicare and Medicaid Services (CMS) to develop a comprehensive strategy to assess the risk of "improper payments" to MA plans. In the coming year, CMS will take a series of steps to measure the accuracy of these payments and address potential risks, beginning with a review of whether all required data is submitted for accurate monthly payments to plans. The agency will examine whether beneficiaries are eligible to enroll in a plan, how payments are made and what occurs when a beneficiary's enrollment is terminated.
EMRs can add to a practice's bottom line
Medicare Part D is the first large scale example of a true consumer healthcare product
We all seem to be taking a wait-and-see approach.
Early in his career, Lyman Dennis, chief information officer (CIO), Partnership HealthPlan of California (PHC), was project manager of a grant from the National Institutes of Health to develop a system that planned diets.
National Reports— In the days after Hurricane Katrina, the Department of Health and Human Services (HHS) demonstrated the value of electronic health records (EHRs) by developing an online database that includes prescription information for the previous 90 days prior to the day Katrina hit for more than 800,000 individuals located in 150 ZIP codes affected by the hurricane.