Medicare Advantage

See the following -

Apixio Illuminates The Pain of Recording Patient Risk Factors (Part 2)

Andy Oram | EMR & HIPPA | October 28, 2016

The previous section of this article introduced Apixio’s analytics for payers in the Medicare Advantage program. Now we’ll step through how Apixio extracts relevant diagnostic data. Providers usually submit SOAP notes to the Apixio web site in the form of PDFs. This comes to me as a surprise, after hearing about the extravagant efforts that have gone into new CCDs and other formats such as the Blue Button project launched by the VA. Normally provided in an XML format, these documents claim to adhere to standards and offer a relatively gentle face to a computer program. In contrast, a PDF is one of the most challenging formats to parse: words and other characters are reduced to graphical symbols, while layout bears little relation to the human meaning of the data...

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Destructive Doctor Relationships Will Destroy Hospitals' Success

Dave Chase | Forbes | September 2, 2016

The highest-performing healthcare organizations fundamentally understand the importance of the forgotten aim in the Quadruple Aim (caring for the caregivers). It’s common sense. My observation turned my inbox into a virtual confessional once I started focusing on the quadruple aim. The bad behavior of far too many hospital CEOs has created collateral damage for the economy and doctors. The only surprise is how most hospital CEOs aren’t recognizing how their actions are self-destructive.

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Humana: Obamacare Exchange Enrollment 'More Adverse Than Previously Expected'

Avik Roy | Forbes | January 10, 2014

On January 9, health insurance bellwether Humana formally announced something that industry observers have long suspected: that healthy and young people don’t think Obamacare’s insurance plans are a good deal for them. [...] The question now is: will taxpayers have to pick up the bill for the Obama administration’s last-minute changes to the law? Read More »

Medicare and Commercial Health Insurance: The Fundamental Difference

Diane Archer | Health Affairs Blog | February 15, 2012

As the debate over Medicare continues in connection to America’s fiscal problems, it is critical to understand how Medicare differs from commercial health insurance for working people. There is a fundamental difference between these two types of health insurance plans, one social and one commercial. Read More »

Private Insurers Have Cost Medicare $282.6 Billion In Excess Payments Since 1985

Press Release | Physicians for a National Health Program (PNHP) | October 10, 2012

Researchers say privately run Medicare Advantage plans have undermined traditional Medicare’s fiscal health and taken a heavy toll on taxpayers, seniors and the U.S. economy Read More »

U.S. Paid Extra $13 Billion for Some Veterans' Care: Study

Andrew M. Seaman | Reuters | June 26, 2012

The U.S. government paid billions of dollars for the medical care of some older veterans twice, according to a new study published on Tuesday. Read More »

What Feds' Push To Share Health Data Means For Patients

Charles Ornstein | NPR | May 9, 2016

Two years ago, when the federal government first released data on how much Medicare paid physicians, the media coverage was widespread. Doctors who earned significant sums were dubbed "Medicare millionaires" and journalists highlighted unusual patterns in how some doctors bill for services. When Medicare released its third round of data last Thursday, the coverage was practically nonexistent. In some ways, that's because data releases from the Centers for Medicare and Medicaid Services have become almost routine...

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