Payers


Health insurance plans serve as the financial backbone of health care, functioning as the crucial link between employers and providers in the $2.5 trillion industry. Topics include: claims management systems, quality improvement programs and claims processing standards.


Clearinghouse Gateway EDI Buys NHXS

Joseph Goedert | May 15
Gateway EDI, a veteran national claims clearinghouse, has acquired NHXS, a revenue cycle management software vendor serving physician practices. Terms of the acquisition were not disclosed.
Electronic Data Interchange
Revenue Cycle Management
Revenue Cycle & Payments
Group Practices
Vendor News

Why ACOs Will Be Different

Gary Baldwin | May 15
Two presenters at the Health 2.0 conference in Boston assert that, unlike the managed care payment models of the past, accountable care organizations have a much better chance of success.
Revenue Cycle & Payments
Revenue Cycle Management
Disease Management
Chronic Care
Health Info Exchange
EHR
Group Practices
Hospitals
Policy & Regulation

The Fallacy of Zero Tolerance … in Hiring

Jim Gibson | May 15
As search consultants, we are usually viewed as trusted advisors and extensions of the management team. So, knowing when to push back on a client, and when to just defer to the client’s opinion and judgment, is one of the trickier parts of our job. It’s a good example of when it’s more art than science.
Vendor News
Hospitals
Group Practices
EHR
Consumer Health

AMA: Postpone ICD-10 At Least Two Years

Joseph Goedert | May 14
The ICD-10 compliance date should, at minimum, be pushed back two years to Oct. 1, 2015, the American Medical Association contends in a comment letter to the Centers for Medicare and Medicaid Services.
Comments (1)
Coding
Electronic Data Interchange
EHR
Group Practices
Hospitals
Policy & Regulation
Revenue Cycle Management

Association for HIT Leaders Comments on ICD-10

Joseph Goedert | May 14
The College of Healthcare Information Management Executives, in a comment letter, expresses support for the government’s decision to delay ICD-10 implementation to October 2014.
Coding
EHR
Decision Support
Group Practices
Hospitals
Revenue Cycle & Payments
Revenue Cycle Management
Policy & Regulation

Deadline Nears for HDM Health I.T Young Bloods Contest

Gary Baldwin | May 14
Entries are now being accepted for the first “Health I.T. Young Bloods” contest sponsored by Health Data Management. The contest deadline is Monday, May 21.
Group Practices
Hospitals
Policy & Regulation

ONC Seeks Input on NwHIN Governance

Joseph Goedert | May 11
The Office of the National Coordinator for HIT has issued a request for information on establishing a governance mechanism for the emerging Nationwide Health Information Network.
Health Info Exchange
Chronic Care
Disease Management
Data Security
Decision Support
EHR
Web Technology
Group Practices
Hospitals
Policy & Regulation

IRS Notices Address Employer Pay-or-Play Under Reform

Edward I. Leeds & Clifford J. Schoner | May 11
In a series of three notices, the IRS has signaled the approach that it may take on certain key issues arising under the employer shared responsibility, or "pay or play,” provisions of the Affordable Care Act and is seeking comment on these and other questions. All of the matters discussed in the notices will ultimately be addressed in regulations.
Policy & Regulation
Revenue Cycle Management

CMS Rule Aims to Cut Regulatory Burdens

Joseph Goedert | May 10
The Centers for Medicare and Medicaid Services has issued a final rule making changes to many regulatory provisions to reduce bureaucratic burdens on providers and promote the efficiency of various programs.
Hospitals
Group Practices
Policy & Regulation

Rep. Ellmers to CMS: Exempt Small Practice and Elderly Docs from Meaningful Use

Joseph Goedert | May 10
Hundreds of public comments on the proposed Stage 2 electronic health records meaningful use rule from the Centers for Medicare and Medicaid Services now are online at regulations.gov, by entering CMS-2012-0022 in the search box.
Comments (1)
EHR
Group Practices
Hospitals
Stimulus
Policy & Regulation

Coalition to CMS: Increase Stage 2 Focus on Data Exchange

Joseph Goedert | May 09
A coalition of stakeholders is asking federal officials to take bold steps to increase health information exchange under the Stage 2 meaningful use program.
EHR
Group Practices
Hospitals
Stimulus
Policy & Regulation

HIMSS: Limit Clinical Quality Measures in Stage 2

Joseph Goedert | May 09
The release date for clinical quality measure specifications under the proposed Stage 2 meaningful use criteria does not provide enough lead time for review, development and certification efforts by vendors, and implementation by providers, according to the Healthcare Information and Management Systems Society.
EHR
Group Practices
Hospitals
Stimulus
Policy & Regulation

Stage 2 Crunch Time Comes for CMS

Joseph Goedert | May 09
Industry stakeholders have filed comment letters on the proposed Stage 2 electronic health records meaningful use criteria, and now the Centers for Medicare and Medicaid Services will start to digest it all.
Hospitals
Group Practices
Policy & Regulation
Stimulus
EHR

RWJ Foundation: Don’t Skimp Stage 2 Criteria for Patient Engagement

Joseph Goedert | May 08
There is much in the proposed Stage 2 meaningful use criteria that the Robert Wood Johnson Foundation likes. But when it comes to patient engagement, the health care philanthropy and research firm wants the criteria enhanced.
Consumer Health
EHR
Group Practices
Hospitals
Stimulus
Policy & Regulation

NCQA: Stage 2 Needs Better Alignment with Other Initiatives

Joseph Goedert | May 08
The National Committee for Quality Assurance, an accreditation firm, is recommending that federal officials tweak proposed Stage 2 EHR meaningful use requirements for group reporting of core and menu objectives.
EHR
Group Practices
Hospitals
Policy & Regulation
Stimulus
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The Price of I.T. Progress?

Looking to build better care coordination, health systems are buying physician groups in droves. Making the deal work, however, requires careful management on the I.T. front.

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