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Note: Health Business Daily will not be published Nov. 26-27 because of the Thanksgiving holiday. The next issue will be sent on Nov. 30.

November 25, 2015

Today's Featured Story

ICD-10 Metamorphosis Calls for New Audit Strategies, Better Dashboard Reporting
Reprinted from Report on Medicare Compliance

Coding audits are due for a retread because of the sheer volume of ICD-10 codes and the accompanying changes in coding logic and documentation, compliance experts say. The audit fundamentals, such as identifying high-risk areas, need to be amplified, with more automation, data analysis and coder education. It’s tricky, because hospitals may be tempted to temporarily reassign auditors to coding if there’s a lag in coder productivity, which translates into less cash flow. But that means fewer audit eyes on the ICD-10 ball.... Read Full Story


From the AIS Blogs

Soundbites From the HHS Pharmaceutical Forum on Access and Affordability

HHS on Nov. 20 held an all-day forum featuring panelists such as consumer and patient advocates, pharmaceutical manufacturers, payers and PBMs. Active discussions took place on the varying factors contributing to rising drug costs and ways to address the complex problem of providing patients with access to innovative new drugs while maintaining affordability, which, of course, led to the topic of value-based purchasing on many occasions. Here are just a few snippets of what participants said throughout the day... Read more


Quote of the Day

“Given the historic culture of payers and providers and the zero sum game they have played, there are payers and providers actually going into these arrangements (ACOs, et al.), but they still have a different cultural attitude, which is a huge challenge to make work. It is one thing to say we want shared savings or capitated payment or to do bundled payments in order to lower costs,...but the bottom line remains that insurers want to pay as little as possible and providers want as much as possible. Until you see cultural change, it is going to be reality vs. rhetoric.”

— Jack Rovner, a principal for The Health Law Consultancy in Chicago, told AIS’s Health Plan Week.

Click here to read the HEALTH PLAN WEEK article in which this quote appeared. (Free for HPW subscribers; $17 for non-subscribers).


Today's Datapoint

87% ... of plans offered on public exchanges cover specialty drugs via one or more specialty tiers, according to a preliminary analysis of 3,152 plan designs sold on individual and SHOP exchanges for 2016, based on data in AIS’s new database Rx Benefit Data.


Today from Washington

People on the Move

Covered California named Kelly Green director of external affairs. Green previously was a principal health consultant for the California State Assembly Health Committee....Flexpoint Ford, LLC appointed Kara O’Brien vice president of investor relations. She most recently was senior marketing and investor relations associate for Brigade Capital Management....Purdue Pharma L.P. appointed Alan Dunton, M.D., senior vice president of research and development. He most recently was founder of Danerius LLC.


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