iLoveBenefits: Industry News Blog

E-health comes of age as a business issue

What is the real cost of inpatient claim errors?

The Real Cost of Inpatient Claim Errors

Over the last decade, the number of facility claims exceeding $100,000 has grown at an unprecedented rate. In 2000, there were three million-dollar facility claims per one million patients in the United States. Today, there are 34 per one million. The average cost of a high-dollar claim has also increased dramatically, from approximately $86,000 in 2000 to $260,000 in 2013. With 80 percent of hospital claims containing errors, the cost to health plans is mounting. Learn how Inpatient Claim Review can help identify up to $1.2 million in annual savings* in our latest infographic, “The Real Cost of Inpatient Claim Errors.” From a 65-year-old man being charged for labor and delivery fees to one patient paying $1,000 for a toothbrush, we’ve included the most blatant examples of:

  • Overcharging
  • Misbilling
  • Unbundling
  • Duplicate Billing
  • Upcoding and Upselling

Free Download

What consumers value from their health insurers

In a recent survey, consumers were asked about what they value from health insurers, and responded:

  • 87%      value coverage of over 90% of health care providers
  • 60%      want claims processing within two weeks of service
  • 49%      want information provided to them in both paper and online formats
  • 43%      value website content that provides information about providers and plan information

Source: “Moment of truth for healthcare: why the customer experience matters, according to new PwC Health Research Institute Report,” PwC’s Health Research Institute Press Release, July 26, 2012, http://www.pwc.com/us/en/press-releases/2012/moment-of-truth-for-healthcare.jhtml

September 4, 2012 | Categories: Benefits,healthcare,insurance | Tags: , , , , | Comments (0)

Medicare data is the key to quality and efficiency in health care

Two senators, a Republican and a Democrat, are pushing legislation to overturn a 1979 court injunction that bars the public from seeing what individual physicians earn from Medicare.

That data, commonly known as the Medicare claims database, is widely considered one of the best tools for identifying fraud and abuse in the $500 billion federal health-insurance program for the elderly and disabled.

It is far more than a look into fraud and abuse. The Medicare claims database is the key to quality and efficiency in health care across episodes of care. What private insurers do not have is an adequate N size in their claims data to do reliable analysis of efficiency when you consider all of the necessary adjustment factors (age, sex, race, comorbid conditions, etc.) Medicare has such a database since it services far more individuals than any one health plan.

Read more here: http://www.marketwatch.com/story/two-senators-push-to-open-access-to-medicare-claims-database-2011-03-02