mThink

There are many types of healthcare fraud. It can be driven by healthcare and insurance providers, patients, employers or any combination of the above. Healthcare providers might make claims for services not provided, or overcharge for services they did provide. They might also submit claims for additional or more expensive services than were strictly necessary. [...]

Do you consider yourself a progressive provider of care? Do you have reimbursement issues with payers? Tired of broken processes? The Pain If you ask any healthcare organization today what their No. 1 concern is, they will likely answer that they want to provide excellent clinical care for their patients, but at what risk? It [...]

In most provider offices today, the patient accounting system is the beginning of the electronic healthcare transaction.When patients arrive, their information is automatically entered or updated in the provider’s patient accounting system. Physician notes on the patient’s examination are reviewed by an assistant who turns key aspects of the patient’s visit into a claim (e.g., [...]

About Amerinet Amerinet is one of the most innovative and effective health care group purchasing organizations in the United States, leading the industry in flexibility with a commitment to providing supplier choice for its members. Amerinet’s national network of companies – Amerinet Central, Intermountain Health Care and Vector – has set the standard for customer [...]

The New England Health EDI Network (NEHEN) was formed in 1998 by a collaborative of nonprofit payers and providers to implement HIPAA administrative simplification for the region. Three of the provider organizations, Partners Healthcare, CareGroup, and Lifespan helped found NEHEN. Boston Medical Center (BMC) joined in December 1999. UMass Memorial and Children’s Hospital joined in [...]

HCT: How has Blue Cross Blue Shield Michigan (BCBSM) been able to work with so many in the provider community to get such a high rate of electronic media? Debbie Fritz-Elliott: In the early ’90s, we targeted efforts to significantly raise electronic claims submission rates. With the help of our consulting partners, we examined root [...]

Care management is multidimensional, dealing with administrative issues such as authorizations and referrals, providing ongoing support through initial and concurrent clinical reviews to help members/patients receive the appropriate level of care at appropriate time consistent with standard practices, and managing complex and chronic medical conditions.

Care management processes include:

A new design in health insurance products, referred to as a consumer-directed health plan (CDHP), has entered the marketplace, and its popularity continues to grow. Trends show that in 2003, enrollment in CDHP-type products more than doubled. According to a January 2004 Inside Consumer-Directed Care, early projections for 2004 put final enrollment numbers somewhere between [...]

Introduction Very few market dynamics over the last 20 years have garnered the attention of the health care payer community as has consumer- directed health care. Over the last four to five years, much has been written – positive and negative – about the concept designed to put health care consumers in control of the [...]