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May 26, 2011

Today’s issue is brought to you by AIS's Report on Medicare Compliance, the nation's leading source of news and strategic information on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers.

Today's Featured Story

Documentation Errors: The Achilles Heel of Compliance Continues to Put Claims at Risk
Reprinted from Report on Medicare Compliance

Insufficient documentation, unsigned orders and related errors continue to trigger many claims denials, according to compliance officers and Medicare officials. These persistent documentation problems also put patient safety at risk.... Read Full Story


From the AIS Blogs

Can Opening State Markets Boost Competition?

Republican governors in Maine and Georgia this month signed similar bills that will allow out-of-state carriers to sell individual coverage policies. Breaking down state barriers isn’t a new idea, and actually was bounced around during the lead up to the reform law. While rates can differ considerably from state to state, one of the biggest reasons is due to state mandates.... Read more


Quote of the Day

"There might have been some confusion among health insurers outside of New York about the controversy surrounding Ingenix [data for deriving usual, customary and reasonable rates], and they opted to move to Medicare as a safe harbor, imperfect as it may be. Medicare is not a satisfactory alternative for establishing rates of reimbursement for out-of-network services…."

— Robin Gelburd, president of FAIR Health, Inc. – the not-for-profit entity created in response to questionable rate-setting practices allegedly used by some N.Y. health insurers – told an April 21 webinar sponsored by AIS.

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

46% … of people being treated for hepatitis C were also taking an antidepressant, according to a new study by Medco.



FierceHealthcare News from our partner FierceMarkets

Most health leaders support federal involvement in reform

When asked their opinion about the authority of states and the federal government over healthcare reform, roughly eight out of 10 leaders in health and healthcare policy said they favored either the balance set by the Affordable Care Act (PPACA) or more authority for the federal government... Read more


Today from Washington

People on the Move

Science Applications International Corporation (SAIC) named David Heimbrook, Ph.D., chief executive officer of SAIC-Frederick, Inc. Heimbrook formerly served as global head of discovery for oncology discovery and translation at Hoffman-LaRoche, Inc. He is succeeding Larry Arthur, Ph.D., who has been the SAIC-Frederick CEO since 2000 and will remain with the firm as its chief scientist….Health Dialog named Robert Mandel, M.D., executive vice president for market and business development. He previously served as senior vice president of health care services at BlueCross BlueShield of Tennessee.


Today's Featured Health Business Job Opening

Catalyst Rx
Director, Clinical Market Intelligence
Anywhere in the U.S.

Place Your Ad Here

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Upcoming Webinars

Global Payments: Health Plan Strategies for the Brave New World of Accountable Care
Tuesday, June 14, 2011

Click here for details.

Strategies for Managing Part D Specialty Formulary Tiers
Wednesday, June 15, 2011

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Insurance Exchanges: How Health Plans and Employers Should Prepare for the Radical Changes Ahead
Tuesday, June 21, 2011

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Medical Loss Ratio Regs: What 2010 Data Suggest About Potentially Huge Rebates in 2011
Thursday, June 23, 2011

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ACO Results and Strategies: A Case Study in Three-Way Risk Sharing
Thursday, June 30, 2011

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Health Plans vs. Drug Coupons: Tactics to Combat Brand-Name Drug Promotions
Wednesday, July 13, 2011

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Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, July 14, 2011

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