Finding Success with Provider-Sponsored Health Plans During Uncertain Times
Community Health Choice, a provider-sponsored health plan started by Harris Health System, has grown its marketplace membership from 300 enrollees to 150,000 over four enrollment periods. Despite uncertainty about the future of federal healthcare laws and the marketplaces, the health plan says that it may still experience growth in 2018.
Auditing for Stark Law Compliance
Compliance with the Stark Law requires involving legal, compliance, and other expertise on the front end of the process rather than auditing for problems later.
Why Health Plans Are Easing Preauthorization
In an attempt to build cooperative working relationships with physicians, some health plans are trying to reduce the burden of preauthorization.
DOJ Guidance on Compliance Effectiveness
New guidance highlights common questions that prosecutors ask when judging compliance program effectiveness.
Managing the ACA’s Nondiscrimination Provisions
The ACA prohibits discrimination in health programs or activities that receive federal financial assistance. Healthcare providers face the challenges of preventing language barriers that may impact certain patients based on race, as well as current litigation on gender identify.
Avoiding the Costliest Denials
Eligibility, outpatient medical necessity, and case management authorization continue to be three of the costliest denials. To avoid the negative effects of these types of denials, it is critical to implement an improvement process based on data.
Using Dashboards to Drive Better Performance
The decision support team at Baptist Health implemented a new tool that provides dashboards to monitor service line performance, profitability, and utilization.
Trending Solutions for Rising Drug Prices
Understanding the efficacy of high-cost drug across large patient populations will help providers, payers, and pharmaceutical companies to understand the value of certain drugs and offer patients their life-saving value.
3 Tips to Ensure Information Governance Success
A hospital health information director shares three strategies to help organizations form an information governance structure.
Children’s Health Raises Efficiency with Revenue Cycle Information Governance
To leverage its data assets toward population health management and other strategic goals, Children’s Health embarked on an information governance initiative that manages data throughout its lifecycle and organizationwide.