Healthcare IT News - March 2008 - (Page 28)

28 Healthcare IT News March 2008 ■ www.HealthcareITNews.com NEWSBRIEFS NEW YoRk AG pRoBE INto top INSuRERS GoES oN A six-month government investigation has led to charges that United HealthGroup subsidiary Ingenix operates a defective and manipulated database that is used by most major health insurance companies to set reimbursement rates. New York Attorney General Andrew M. Cuomo revealed the results of his investigation last month and announced he is conducting an industrywide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. At the center of the alleged scheme is Ingenix, the largest provider of healthcare billing information in the country, which serves as a conduit for rigged data to the largest insurers, Cuomo charged. QualChoice gets tough on fraud Integration key to getting handle on detection. By PaTTy ENrado, Contributing Editor LITTLE ROCK, AR – QualChoice of Arkansas, a managed care company and health benefits administrator, is implementing TriZetto Group’s fraud, waste and abuse (FWA) suite to reduce costs of lost to fraud and waste – an industry standard that is 2 percent to 3 percent. QualChoice, which already uses TriZetto Group’s Facets core administration system, will be the first Facets client to benefit from the integration of these solutions, said Robert McGinley, vice president, detection and recovery services for Plan Data Management, a division of TriZetto Group. Fraud detection software needs to be tied to the core administration system because the biggest hurdles in fraud detection are the inhibited flow of clean data and the lack of “We needed to develop an overall internal and external strategy to be proactive around FWA activity.” – Haley Wilson clean data itself. “We wanted to enhance detection technology and have it work as part of the core administration system,” McGinley said. Janice Young, program director for Health Industry Insights, an IDC company, said TriZetto Group is on the right track. “If you are trying to identify fraudulent acts, you need integration with the back-end system,” she said. Integration would enable the seamless pulling of data and analysis of such things as fraudulent billing trends, as well as information sharing. “We needed to develop an overall internal and external strategy to be proactive around FWA activity,” said Haley Wilson, CIO of QualChoice. “By using Plan Data Management as our special investigator unit and utilizing TriZetto Facet’s claim adjudication system, we will have an integrated approach around our FWA process.” QualChoice chose to outsource its FWA program because the technology and processes to detect fraudulent activity are becoming FraUd see page 30 kENtuckY plAN GoES to ElEctRoNIc chARGE cAptuRE The Kentucky Medical Services Foundation in Lexington, Ky., is moving to an electronic charge capture system for its clinician base of more than 600 providers. KMSF is the faculty practice plan for the University of Kentucky Medical Center and the College of Medicine. The foundation has selected technology developed by Boston-based MedAptus. MedAptus’ Professional Charge Capture supports compliant and streamlined coding at the point-of-care. The system is integrated with numerous scheduling, billing and registration EMR systems. Kaiser rolls Call ahead Regional initiative will out e-commerce platform Program enable brokers to do reaps roI business online. By PaTTy ENrado, Contributing Editor By PaTTy ENrado, Contributing Editor LAS VEGAS cAREFIRSt hElpS pRovIdERS WIth EhR pRojEctS CareFirst BlueCross BlueShield has invested more than $1.5 million in two electronic health records projects in Maryland. It has pledged $967,000 to plan and implement an electronic health record system at Community Health Integrated Partnership in Glen Burnie, a group of seven community health centers. The company said it would also contribute $550,000 to an $800,000 EMR project at LifeBridge Health. – ScripNet’s Call Ahead Program, which preapproves correct prescriptions, pre-registers with pharmacies and directs injured workers to the closest pharmacies to get their m e d i c a t i o n s , Dennis Sponer has delivered ROI for payers, pharmacies and patients. ScripNet has documented an increase in generic drug use, electronic adjudication and average percentage of roI see page 30 cIGNA ExtENdS coNtRAct WIth hEAlthWAYS Cigna HealthCare signed a three-year contract extension with Healthways Inc. to provide care management and wellness programs through February 2013. Nashville, Tenn.-based Healthways provides services including call centers and nurse educators that help Cigna members better manage their illnesses, avoid unnecessary hospitalization, and stop or slow the progression of their disease. Financial terms of the deal were not disclosed. The programs serve about 1.2 million members. More at Hospital execs give United low grades – United Healthcare received the most unfavorable ratings among hospital executives in a new survey that rated health insurance companies on a dozen topics, which included reducing hospital paperwork, claims processing and paying hospitals promptly. Public affairs agency DAVIES conducted the second annual survey, which measured hospital executives’ perceptions of the nation’s largest health insurance companies. The survey targeted hospital leaders who negotiate contracts with major insurance companies WASHINGTON MOUNTAIN VIEW, CA – Kaiser Permanente’s Mid-Atlantic Region is licensing eHealth’s ecommerce technology, which will enable Kaiser’s brokers and agents in Maryland, Virginia and the District of Columbia to prepare quotes and submit applications through a broker Web site. The proven concept of online purchasing is being extended to the health insurance market and will result in driving more business for payers and brokers, said Sam Gibbs, senior vice president of eHealth. “The Internet lends itself to this product,” he said. “One of our key goals is making working with us as easy as possible,” said Kim Rucker, segment manager for individual products tions online. Brokers will be able for Kaiser Permanente’s Mid- to manage their book of business Atlantic Region. She said Kaiser online. A more efficient, streamwas responding to its broker com- lined paperless application promunity’s desire to submit applica- cess will create better consumer and broker/agent experitions online. ences, he said. “Kaiser Permanente Gibbs noted that the embraces the use of techindustry average to apply nology,” she said. This and get covered by health implementation would insurance is three weeks. decrease mailing and The technology can paper costs, eliminate potentially reduce that to incomplete and inaccu- Sam Gibbs rate applications, which would real-time. He said the industry is in turn speed up turnaround moving toward deeper integration of an Internet platform that time. The trend eHealth is seeing can produce instant underwritis the ability to take front-end ing and issuance of cards with a processes such as applications point and a click. “The opportunity to revolutionand carry them over to a payer’s back-end system, which includes ize the process is tremendous,” he underwriting and member man- said. “We are past the early adopagement systems. Consumers tion point and into mainstream.” ■ will be able to compare different More at HealthcareITNews.com Kaiser plans and submit applica- ●Connect: KaISer 0308 e HealthcareITNews.com e ●Connect: PaYerS 0308 – hospital CEOs, CFOs, and directors of managed care. Participants represented more than 10 percent of U.S hospitals. Ninety-one percent of those surveyed indicated an unfavorable opinion of United Healthcare. This compares with an average unfavorable rating of 41 percent among all other insurers in the survey. Last year’s survey reached a similar conclusion with 87 percent of participants ranking United as “difficult” or “very difficult” to deal with. ■ More at HealthcareITNews.com e Connect: ratING 0308 Rating payers on paperwork Best at reducing paperwork for hospitals State/Regional 25% BCBS 19% Aetna Wellpoint/Anthem 17% Cigna 12% Coventry/First Health 11% United 10% Other 16% e ● Connect: GraPHS 0308 Worst at reducing paperwork for hospitals United -28% Wellpoint/Anthem -16% Cigna -12% State/Regional BCBS -10% Aetna -10% Coventry/First Health -8% Other -7% SoURCE: DAVIES 2008 NATIoNAL PAYoR SURVEY ● http://www.HealthcareITNews.com http://HealthcareITNews.com http://www.healthcareitnews.com/story.cms?id=8881 http://HealthcareITNews.com http://www.healthcareitnews.com/story.cms?id=8883 http://HealthcareITNews.com http://www.healthcareitnews.com/story.cms?id=8882

Table of Contents Feed for the Digital Edition of Healthcare IT News - March 2008

Healthcare IT News - March 2008 Contents No. 1 E-prescribing ‘Quite Bright’ Bill Frist on IT Google Connection Poised for P4P ‘Smashing Success’ Tough On Fraud It's Analytics Getting Rid of the Pain Stuck In Neutral

Healthcare IT News - March 2008

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