How can providers increase quality of care while reducing cost to patients? The answer is through innovation, creativity, increased patient responsibility, partnership, and real-time flow of information. Here are just a few ideas to consider in reaching this overarching goal. While none of the ideas articulated below are novel or groundbreaking on their own, they …
Launch of the Criminal Division’s In-House Health Care Data Analytics Team
In its “2017 Year in Review” (https://www.justice.gov/criminal- fraud/file/1026996/download), the Fraud Section in the Criminal Division of the US Department of Justice announced the launch of its Health Care Fraud Unit’s Data Analytics Team. While the use of data analytics is not new to the Department of Health and Human Services and civil enforcement section of …
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As Telemedicine Soars, Reimbursement for Telemedicine Services Slowly Evolve
The use of telemedicine has soared in recent years, as new technologies develop and consumer demand for instant access to healthcare increases. Indeed, the telemedicine market is expected to grow to $113.1 billion by 2025, at an estimated compound annual growth rate of 18.8%. It is expected that at least 7 million patients in the …
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Obligations and Expectations Surrounding Healthcare Compliance Programs
The phrase “healthcare compliance program” is commonly used to describe those processes and procedures implemented by a healthcare provider to prevent submission of erroneous claims and combat fraudulent conduct. The expectation is that providers using internal controls will more efficiently monitor adherence to legal and regulatory requirements than providers without such controls in place1. However, …
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Is Your Physician Organization Complying with Antitrust Law?
It is not uncommon for a physician organization to act as an intermediary between its physician participants and third-party payers to facilitate the negotiation and acceptance of reimbursement rates and other payer contract terms. However, when facilitation becomes negotiation and a PO accepts contracts with third-party payers on behalf of physician participants, also known as …
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Blessings in Disguise: Hidden Opportunities in Health Care Bankruptcies
In 2016 alone, 21 hospitals were closed across the United States because of unsustainable financial performance1, and the trend has continued with 7 additional hospitals and 18 other hospital departments closing in just the first half of 20172. Financial challenges facing many entities in the health care industry are not limited to hospitals, or even …
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