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July 29, 2014 | Anthony Brino

Lawmakers, taxpayers and health organizations concerned about Medicare's sustainability can breathe a small sigh of relief, if not hold their breath.


July 28, 2014 | Anthony Brino

Incorporating federal sequestration into Medicare Advantage provider reimbursement has spurred a new lawsuit, and one that could spell trouble for other plans.


July 15, 2014 | Anthony Brino

Evidence from recent federal enforcement actions suggest pharmacy benefit managers are exposing public-payer managed care plans to problems that could send shivers up executive's spines.


May 29, 2014 | Anthony Brino

Medicare Advantage insurers may soon find themselves facing new public scrutiny over potential spending and overpayment discrepancies.


May 27, 2014 | Anthony Brino

The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled.


May 27, 2014 | Charles Ornstein, ProPublica

The federal government has granted itself potent new authority to expel physicians from Medicare if they are found to prescribe drugs in abusive ways, following through on a proposal issued earlier this year.


April 25, 2014 | Anthony Brino

Not-for-profit hospitals are facing huge revenue challenges amid payment reform and shifting payer mixes, leaving relationships with commercial insurers in a flux.


April 23, 2014 | Diana Manos

The brains behind implementing much of the Affordable Care Act's new Medicare policies, Jonathan Blum, principal deputy administrator at the Centers for Medicare & Medicaid Services, will be stepping down from his position on May 16.


April 15, 2014 | Anthony Brino

After finding one state shifting millions in Medicare-Medicaid dual eligible costs to the feds, Medicare's watchdog suspects more may be doing the same.


April 14, 2014 | Anthony Brino

Highmark sees a market for guiding the millions of American adults helping their aging and ill parents, relatives and friends.


April 11, 2014 | Anthony Brino

Centers for Medicare & Medicaid Services leaders point to seniors' wide array of Medicare Advantage and Part D choices as evidence of the program's and insurer's health, but regulators may soon be terminating dozens of plans, unless sponsors pull out first.


April 11, 2014 | Eric Wicklund

Sometimes the best solution is the simplest one. That's what some payers are finding out, for instance, with a home monitoring solution that tracks activity, rather than vital signs, for seniors and their caregivers.


May 19, 2014 | White Papers
If your organization enters or changes data manually, or is using a series of macros cobbled together to automate enrollment, claims reprocessing, or panel updates, you’re probably losing time, money, and risking data quality. This study explores the causes, prevalence, and repercussions of these traditional data practices for payers, then shares innovative ways to conquer inefficiency with automation technology.

November 22, 2013 | White Papers
This case study reveals how one Medicare Advantage health plan boosted its productivity during AEP by 102% and grew its membership by 40% while reducing staff. Learn best practices that include broader automation, increased accuracy and compliance, and instant eligibility verification that will enable your organization to experience a new level of operational efficiency and productivity during the next annual enrollment period.

November 20, 2013 | White Papers
Whether they realize it or not, most healthcare payers are losing millions of dollars each year across activities such as COB, subrogation, eligibility, MSP validation, and more. Fortunately, a new generation of "intelligent" cost containment solutions helps cut the losses and achieve significantly improved recoveries, cost avoidance, and increased revenue - all of which support health reform priorities such as medical loss ratio and waste and abuse efforts. This white paper details real-world examples of "intelligent" cost containment success, best practices for improvement, and more.

October 9, 2013 | On Demand Webinars
The healthcare sector is going through massive transformation. Payers have to invest in readiness around data delivery to federal and state or multiple health insurance exchanges before Jan 1, 2014 deadline. While the ICD-10 adoption deadline has been pushed back due to industry pressures on regulator - it is still a huge undertaking for any healthcare entity that touches diagnostic or procedural codes. These are just some of the projects that are converging on healthcare IT teams this year. For healthcare CIOs and IT teams and especially application development teams this project overload translates into a cascading capital and operational cost burden. Learn how Presbyterian reduced storage, operational costs and realized significant productivity benefits around critical business processes.

October 9, 2013 | White Papers
Healthcare reform is transforming the US medical insurance sector - creating a dynamic and competitive new market with compelling opportunities for growth. But do you have the necessary responsiveness to capitalize on these opportunities? Here are the five compelling ways technology investment delivers agility you need - and how.

April 4, 2013 | White Papers
Accountable care offers the nation’s ailing health care system new hope — but it isn’t a new idea. For the past decade, health systems, payers, and providers across the country have been practicing accountable care principles through initiatives such as the Collaborative Payer™ Model, a care delivery innovation jointly developed by a payer and provider that approximates an accountable care organization.

April 4, 2013 | White Papers
This case study profiles a struggling Medicare Advantage business responsible for 11,600 lives in the southeastern United States. Lumeris recommended that the client implement the Collaborative Payer™ Model, an approach to improving clinical and cost outcomes via a strong payer-provider relationship. The company guided the client through a three-phase approach to develop this model, achieving outcomes including: earning appropriate revenue, reducing unnecessary utilization, improving quality metrics, and improving cost outcomes.

June 20, 2012 | White Papers
Insurers are efficiently and accurately paying millions of claims that they should never pay at all. In this white paper we define state-of-the-art prepayment analytic strategies and explain how they differ from both claims edit and postpayment detection systems.

June 20, 2012 | White Papers
In this case study, you’ll learn how Highmark dramatically reduced losses with a new analytic approach to preventing and detecting fraud, waste and abuse in submitted claims. Learn how this approach enabled Highmark to identify hundreds of new pursuable cases in the first year over and above cases identified through other methods.

WEBINARS AND WHITE PAPERS

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