Claims Processing
The Medicaid subsidiary of New Jersey’s largest healthcare insurer, Horizon Healthcare Services, is rolling out a new provider communications portal aimed at making communications between physicians and insurer easier and more efficient.
Attorney General Kamala D. Harris announced a $241 million settlement on Friday – the largest recovery in the history of California's False Claims Act – with Quest Diagnostics, the state's biggest provider of medical laboratory testing, to recover illegal overcharges to the state's medical program for the poor.
TRICARE, the Department of Defense healthcare program, has contracted with San Mateo, Calif.-based Epocrates to offer physicians mobile access to the TRICARE formulary list.
Health plans are stepping up to become key players in forming accountable care organizations.
Department of Health and Human Services officials have launched a new program, developed under the Affordable Care Act, aimed at eliminating medical errors on a national scale.
On March 31, the Centers for Medicare & Medicaid Services proposed new regulations for accountable care organizations. While they are complex – in excess of 400 pages in length – it is also clear that technology will play a significant role in implementing ACOs.
With the continuing weak economy and the advent of health reform, bundled reimbursement and accountable care organizations expected to ratchet up the financial pressure on their businesses, physicians are increasingly looking to health systems as employers.
The Department of Veterans Affairs plans to contract for management services to streamline and modernize the processing of its healthcare claims and develop tools to detect fraud and waste. It will also update IT services to help control costs in its beneficiary travel program.
A new study by a Stanford University research team, published in the Archives of Internal Medicine, has found that using EHR and clinical decision support technology may improve administrative efficiency but does "not appear to translate into better outpatient quality of care."
HealthPoint, a network of 12 not-for-profit clinics in suburban Seattle, has reaped significant cost savings by consolidating IT that had been spread throughout seven of the network's facilities.