A change to Medicaid regulations will allow state fraud control units use federal funding to analyze Medicaid claims data for fraud prevention and tracking, with states given some autonomy in going beyond Medicaid data sets.
Florida has some of the highest public program fraud rates in the nation, and it's also the first state to adopt a front-end fraud prevention technology for social and health programs, with a pilot in greater Orlando.
In this era of reform, Medicaid organizations must tackle evolving regulatory requirements, stretch budget dollars even further and address the dramatic shift to consumer empowerment - all while driving higher quality outcomes. Success will require new operational models, new processes, and next-generation technologies. Attend to hear how Medicaid has the potential to become a national leader in effective, high quality care - and the crucial role technology must play in adapting for the future of Medicaid.
Today, as states struggle with budget pressures and brace for the national reform, interest in various managed care strategies continues to grow. A well-executed managed care effort can help control costs while improving access and quality of care. This paper addresses how to evaluate, deploy, and administer managed care systems in the Medicaid environment.
Medicare Advantage (MA) plans are private health plans that have contracted with Medicare to receive a fixed monthly fee in exchange for providing comprehensive healthcare to plan members. In order to provide appropriate care to beneficiaries with varying medical conditions, plans are paid according to the Risk Adjustment Factor (RAF) score of each patient. Insufficient documentation of chronic conditions can be an obstacle to MA reimbursement. However, even when a condition has been properly documented by the provider, it is often not coded and submitted to Medicare. Read this white paper to learn how to take the complexity out of MA reimbursement.
In this solution brief we recommend a reference architecture that can be implemented with Intel® Expressway Service Gateway for Healthcare (Intel® ESG for Healthcare) – reflecting the unique legacy protocols in healthcare, the services required for the exchanges, and the impact of strict security laws on the overall architecture. This paper is intended for healthcare solution specialists, technology architects, business analysts in the healthcare industry, Healthcare SMEs, executives, state level health and human services implementers, system integrators who are looking to build state HBE systems, and other potential customers.
In this Web seminar, learn firsthand from five healthcare organizations how, after integrating Perceptive Software enterprise content management (ECM) products, they are realizing cost and time-saving benefits enterprise-wide. The customer panel will share lessons learned and best practices for deploying ECM technology with their business and health information systems.
This week in Government Health IT: Reports expose state and local governments as ill-prepared, whether that be for Big Data or cyber-attacks. Also, think tanks talk patient-centered care for cost-savings.
While the President and Congress look for deficit reduction paths and healthcare organizations brace for Medicare changes, the duo from the Fiscal Commission is renewing its plans for spending cuts ($600 billion in healthcare) and new tax revenue.
A large percentage of the Americans that the Affordable Care Act aims to bring into the insurance pool access the Web primarily through their smartphones. For the ACA to achieve its potential, federal and state governments must reach those citizens where it's most convenient for the consumer.