New Partnership Combats Healthcare Fraud

There is now a new partnership between health insurers and both federal and state governments. Because of the increased scrutiny of healthcare fraud, this partnership will enable the sharing of data and facilitate the cooperation of investigative best practices to reduce fraud and prevent questionable payments.

Each year, fraud costs Medicare alone approximately $60 billion. U.S. Health and Human Services Secretary (HHS) Kathleen Sebelius expects the partnership will produce results within 12 months. However, there is no budget and claims-data sharing will undoubtedly face significant legal and technical challenges.

Some of the partnership possibilities include:
■ using claims data to catch fraudulent payments
■ sharing information on new fraud schemes
■ utilizing computer analysis to identify emerging fraud patterns

HHS stated a third party will be engaged to sift through Medicare and Medicaid, as well as private health insurance information in order to turn over questionable billing to investigators.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

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Outpatient Care Supports Hospitals

Many large for-profit hospital systems have reported noteworthy growth in revenue even though they experienced declines in admissions. These performances are attributed to outpatient care increases which counters a lackluster inpatient volume.

Health Management Associates reported a 5.7% same-facility revenue increase, but an admissions drop of 4.2%.  Life-Point Hospitals reported a 4.2% same-facility revenue increase, but a decline in admissions of 3.9%.

Aside from outpatient care being a more cost-effective delivery means, it also is attracting more patients who have commercial health plans due to the tightening of reimbursement on Medicare and Medicaid.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Congressional Budget Office Reports on Healthcare Ruling

After the U.S. Supreme Court ruling in June, the Congressional Budget Office (CBO) produced a report stating that the law could possibly save the government $84 billion over the next 11 years.  This projected savings comes from the fact that the Court’s ruling allows for states to forgo an expansion of their Medicaid programs.  Such expansion would be funded mostly by the federal government.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.