It’s an unfortunate truth: Fraud, waste and abuse (FWA) runs rampant across the healthcare marketplace. According to several industry sources, in 2011 more than $98 billion was lost due to Medicare and Medicaid fraud, waste and abuse alone and tens of billions of dollars more at commercial health plans. In fact, estimates suggest between three and ten percent of all U.S. dollars spent on healthcare services are attributed to this issue. With healthcare costs continuing to hamstring the nation’s economy it’s an epidemic that insurers and providers simply must get under control.
The Affordable Care Act (ACA) most certainly recognizes the importance of addressing the nation’s fraud, waste and abuse problem. In fact, this new healthcare legislation dedicates $350 million to be spent during the next 10 years to help fight the issue. In addition, the ACA includes several new rules and penalties designed to help reduce the amount of healthcare fraud happening each year. But it’s not enough. Read more
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Fraud, Waste and Abuse: What today’s leading organizations are recommending to transform unnecessary costs into a strategic opportunity
2014 is Right Around the Corner – Are you Ready?
Healthcare reform is underway. Will your organization be ready to distribute claims payments via Electronic Funds Transfer (EFT), offer electronic enrollment for EFT and comply with other EFT-related guidelines?
Emdeon recognizes the challenges you face on the path to achieving compliance by January 1, 2014. That’s where we come. Our EFT Mandate Resource Page is designed make sure you’re asking your compliance partner the right questions, helping you plan appropriately. Learn more
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Enabling the Future: Modernizing Core Administration Systems – Planning a System Implementation, an HTMS whitepaper
As a result of healthcare reform, consumer driven markets, and other industry transforming dynamics, many health plans have found they cannot support their current and future operations with their current core administrative systems. While this rapidly changing environment presents many challenges— including medical loss ratio caps and the operational and technical requirements that could be mandated for plans that participate in Health Insurance Marketplaces (HIMs)—it also creates significant opportunities. Health plans must ensure their transactional systems are robust, efficient, flexible and based on an extensible architecture.
Organizations know that replacing a core system is a significant undertaking, and most make good faith efforts to plan and prepare accordingly. Nonetheless, it’s easy to underestimate the degree to which these projects will affect all aspects of the business and the inherent risks associated with such endeavors. A core system implementation or replacement project is truly an enterprise-wide business and technology transformation initiative. Most organizations that have lived through a core system modernization agree that the effort was, in hindsight, much more challenging, expensive and time-consuming than anticipated. Read the full whitepaper
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Upcoming Emdeon Insights Payer Webinars:
1. HIPAA Regulations: Pilot Testing New Versions
CMS/OESS awarded Emdeon with a contract to explore the concept of pilot testing of new versions of HIPAA standards. Join Emdeon on Monday, November 4th, for a regulatory webinar about pilot testing new versions of ASC X12! Register today!
2. Fraud, Waste and Abuse—Transform Unnecessary Costs into Strategic Opportunities
Join us on Tuesday, October 29th, as Kelli Garvanian, payment integrity solutions consultant, and Jim McCall, director of payment integrity solutions and fraud analytics, discuss today’s biggest challenges and explore how business leaders are employing creative strategies to combat fraud, waste and abuse. Register now!
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Are you COMPLETE?
Have you heard the latest buzz? Emdeon Payer Complete is the single solution for COMPLETE claims, payments, cost containment and payment integrity. By combining Emdeon’s industry-leading EDI services, world-class payment integrity services, and the largest healthcare payment network in the industry, Emdeon Payer Complete provides one complete solution. All for less. Learn more.
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Visit Emdeon at these Upcoming Conferences
Emdeon stays on top of all the latest national health care trends by attending and participating at many industry trade shows and conferences each month. View Emdeon’s complete upcoming conference and trade show calendar at http://www.emdeon.com/tradeshows/.
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