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Retrieving Billions in Overpayments by CMS
This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. The article is based on an interview with Kel Pults, chief clinical officer and vice president of MediQuant. A future article will explain how Medicare Advantage plans are trying to improving data collection and reporting, and how AI helps.
Challenges of Investigating Overpayments
Undeserved payments are needles lurking in the haystack of 135 million Americans enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). But the needles pile up fast. Improper payments f...
Source: EMR and HIPAA - February 17, 2023 Category: Information Technology Authors: Andy Oram Tags: AI/Machine Learning Analytics/Big Data Health IT Company Healthcare IT Regulations Revenue Cycle Management #COVID19 CMS COVID Reimbursement Healthcare AI Healthcare Analytics Kel Pults MAOs Medicare Advantage MediQuant Overp Source Type: blogs
All Three Legs of the Obamacare Stool Are Working Well – Part 2
BY GEORGE HALVORSON
2022 Medicare Advantage data gathering process change made last year just made upcoding for plans irrelevant and impossible, but the critics do not accept that it happened.
CMS just ended that upcoding debate for 2022 by completely killing the coding system for the plans, effective immediately. The plans can’t code risk levels up because the coding system was eliminated entirely for 2022.
RAPS is dead.
The payment approach for Medicare Advantage now has no upcoding components and the government just used their new and more accurate numbers to create the 2023 payment level for the pla...
Source: The Health Care Blog - February 17, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Affordable Care Act Medicaid Medicare Medicare Advantage Obamacare Source Type: blogs
Mark Cuban Cost Plus Drug Company ( " MCCPDC " ) PBC May Be Able to Say " Mission Accomplished " Even if Sales Stop Growing
On January 19, 2022, a startup called theMark Cuban Cost Plus Drug Company ( " MCCPDC " )opened its doors to the American public as a new online pharmacy and generic manufacturing startup. Initially, MCCPDC was also planning to launch its own Pharmacy Benefit Manager, but it later scrapped those plans, instead announcing several PBM partnerships with some PBM startups which do not engage in " spread pricing " , including on generic, biosimilar and " authorized generic " drugs. The company bears the name of its famous principal investor, multibillionaire Mark Cuban, who is perhaps best known as both owner of the NBA te...
Source: Scott's Web Log - February 7, 2023 Category: Endocrinology Tags: authorized generic 2023 Alex Oshmyansky authorized generics Biosimilar biosimilars Cost Plus costplus drug company drug prices drug pricing generic drugs mark cuban Mark Cuban Cost Plus Drug Company Source Type: blogs
13 Year Old McAllen
BY IAN MORRISON
As a Scot, obviously I am a whisky fan, and although I prefer the smoky malts of Islay (where my grandfather was from and where I visit my friends there frequently), I am also a huge fan of McCallan 18-year-old whisky, the sticky toffee pudding of single malts.
But as all policy wonks know, McAllen Texas is not famous for whisky but for Atul Gawande’s “Cost Conundrum” article in the New Yorker, in 2009 which is still required reading in medical school and MPH classes and was arguably the cornerstone of Obama health policy and the ACO movement.
Dr. Atul Gawande described overutilization and hi...
Source: The Health Care Blog - February 2, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: The Business of Health Care Affordable Care Act Atul Gawande Ian Morrison McAllen Texas Source Type: blogs
Caught in the middle: How health insurance companies influence cancer drug selection
Patients may find themselves caught in the middle between their health insurance company and their oncologist when it comes to selecting the drugs used to treat their cancer. Why is this? The American Cancer Society explains biologic drugs (derived from living organisms such as yeast, bacteria, or animal cells) and biosimilar drugs, which behave similarly
Read more…
Caught in the middle: How health insurance companies influence cancer drug selection originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - January 12, 2023 Category: General Medicine Authors: Paul Pender, MD Tags: Meds Oncology/Hematology Source Type: blogs
Onc.AI Raises $25 Million Series A Financing Co-Led by MassMutual and Action Potential Venture Capital
Financing will support commercialization of a novel digital clinical management solution focused on immuno-oncology therapies
Onc.AI, a medical technology company developing a novel digital clinical management solution focused on immuno-oncology, announced today it has closed a $25 million Series A financing co-led by MassMutual and Action Potential Venture Capital (a GSK venture fund). Also participating were Life Extension Ventures and all existing investors including Blue Venture Fund, Accomplice, Digitalis Ventures, and KdT Ventures.
“Having first learned about Onc.AI through a leading precision-oncology expert, we a...
Source: EMR and HIPAA - January 10, 2023 Category: Information Technology Authors: Healthcare IT News Tags: Genomics-Precision Medicine Health IT Company Healthcare IT Accomplice Action Potential Venture Capital Akshay Nanduri APVC Blue Venture Fund David Diaz-Casariego Digitalis Ventures Dr. Emir Sandhu Dr. Julie Hambleton GlaxoSmithKli Source Type: blogs
Evidence based medicine and politics
I ' m not sure if you can read this -- I have a cookie that gives me access, but the URL doesn ' t include the proxy server and it appears to be accessible. Let me know. Anyway, it ' sa discussion in NEJM of the U.S. Preventive Services Task Force. The USPSTF is a panel of clinical experts convened by the Agency for Healthcare Research and Quality, AHRQ, which is usually pronounced like ark. It draws on available research to evaluate screening tests and preventive interventions. An A or B grade means they recommend it. A C grade means it might be worthwhile for some people, but you should discuss it with your doctor and ma...
Source: Stayin' Alive - January 5, 2023 Category: American Health Source Type: blogs
6 Potential Medical Use Cases for ChatGPT
The internet is buzzing with news on ChatGPT, and how everyone uses it to write love poems, homework, summaries of articles, or python codes. ChatGPT is the latest generation of a large language model, designed to generate text upon user input. There is a lot of discussion regarding its potential use in medicine, so let’s see, what you can expect from it and what you should not use it for – at least in its current form.
Unlike the text-to-image tool Midjourney, which we introduced earlier, and which is a GAN (generative adversarial network, explained here) algorithm, ChatGPT is a different kind of algorithm R...
Source: The Medical Futurist - December 19, 2022 Category: Information Technology Authors: Andrea Koncz Tags: TMF Artificial Intelligence in Medicine AI chatbot AI text generator AI in heaalthcare ChatGPT Conversationlal_AI Source Type: blogs
Room for Innovation in Digital Transformation
Digital Transformation is a huge buzz word in the world of healthcare at the moment. With the pandemic, we had to scramble to find a digital way to do many things in order to stay safe. So in a lot of ways, healthcare has been skyrocketed into the future, but there is still room for improvement. For some organizations, being rushed to find a digital solution has left certain areas unsupported. This rush also means that not all organizations have adopted the same practices that patients have grown to love and are now trying to catch up. So while we have made huge progress in the world of digital transformation, there is sti...
Source: EMR and HIPAA - December 7, 2022 Category: Information Technology Authors: John Lynn Tags: C-Suite Leadership Healthcare IT IT Infrastructure and Dev Ops 4D Path ABOUT Healthcare Alan Stein Amanda Bury Andrew Rickman Angie Franks Bamboo Health Brandon Clark Catalyst Health Group Chris Evanguelidi CloudWave Digital In Source Type: blogs
Undisclosed Conflicts of Interest by Physicians Creating the CDC Opioid Prescribing Guidelines: An Epilogue
by Chad D. Kollas, MD, Beverly Schechtman and Carrie JudySeveral important developments have occurred since the publication of our article, “Undisclosed Conflicts of Interest by Physicians Creating the CDC Opioid Prescribing Guidelines: Bad Faith or Incompetence? ” in Pallimed on September 12, 2022 (1). Most notably, this includes the publication of the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2), which updated the guidance previously provided by the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain (3). In this epilogue, we will describe those important developments and examine ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 29, 2022 Category: Palliative Care Tags: CDC judy kollas opioids schechtman Source Type: blogs
Promises Made – Promises Kept: President Biden’s Support for “Obamacare.”
BY MIKE MAGEE
As the saying goes, “History repeats!” This is especially true where politics are involved.
Consider for example the past three decades in health care. It is striking how many of the players in our nation’s health policy drama remain front and center. And that includes President Biden who recently commented on the 12th anniversary of the passage of the Affordable Care Act (Obamacare):
“The ACA delivered quality, affordable health coverage to more than 30 million Americans — giving families the freedom and confidence to pursue their dreams without the fear that one accident or il...
Source: The Health Care Blog - November 2, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Affordable Care Act Biden Obamacare Source Type: blogs
The Macro View – Health, Economics, and Politics and the Big Picture. What I Am Watching Here And Abroad.
October 27, 2022 Edition-----In the UK we have a political farce running with only a day or so to run when you read this, with a new PM (Rishi Sunak) in place..In the US the mid-term elections are coming in a week or so, thus some concern as to where the US is going!In China Xi has his third 5 year term so we all wonder how that will turn out!In OZ we have has a Budget with floods, inflation, data leaks, the threat of recession, Medicare concerns and other issues just rolling on! At least the Budget does not seem to have broken anything!Overall an ‘omnishambles’ as they say!-----Major Issues.-----https://www.afr.com/wo...
Source: Australian Health Information Technology - October 27, 2022 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
Commentators and Journalists Weigh In On Digital Health And Related Privacy, Safety, Social Media And Security Matters. Lots Of Interesting Perspectives - October 25, 2022.
-----This weekly blog is to explore the news around the larger issues around Digital Health, data security, data privacy, AI / ML. technology, social media and any related matters.I will also try to highlightADHA Propagandawhen I come upon it.Just so we keep count, the latest Notes from the ADHA Board were dated 6 December, 2018 and we have seen none since! It ’s pretty sad!Note: Appearance here is not to suggest I see any credibility or value in what follows. I will leave it to the reader to decide what is worthwhile and what is not! The point is to let people know what is being said / published that I have come upon, a...
Source: Australian Health Information Technology - October 25, 2022 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
Dr Margaret Vaux Has Exposed A Problem With Health Department / Medicare Technology!
Last Monday the ABC and The Nine News Outlets made a big splash with the following headlines:‘Medicare is haemorrhaging’: The rorts and waste costing taxpayers billions of dollars a yearByAdele Ferguson and Chris GillettOctober 17, 2022 — 5.00amBillions of dollars are being rorted from Medicare each year by medical practitioners making mistakes or charging for services that aren ’t necessary or didn’t even happen – including billing dead people and falsifying patient records to boost profits.The revelations come as GPs lobby the federal Labor government to boost Medicare funding and increase rebates, claiming t...
Source: Australian Health Information Technology - October 23, 2022 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
Weekly Australian Health IT Links – 17 October, 2022.
Here are a few I have come across the last week or so. Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.General Comment-----We seem to have an epidemic of cyber leaks this week.Otherwise a few fun bits as usual and a few new apps.-----https://itwire.com/science-news/health/a-free-mobile-app-helps-people-track-early-dementia-diagnosis.htmlThursday, 13 October 2022 11:15A free mobile app helps people track early dementia diagnosisByKenn Anthony MendozaHe...
Source: Australian Health Information Technology - October 17, 2022 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
