Thanks to the American Recovery and Reinvestment Act of 2009 (ARRA) (the economic stimulus package for the U.S. economy), healthcare reform, and the Health Information Technology for Economic and Clinical Health Act (HITECH), the next five years will see a dramatic increase in outsourcing in the healthcare industry. But there are significant challenges for decision […]
Infocrossing’s Contract with CMS Helps Medicare Advantage and Medicare Part D Plans with Enrolling Members and Reconciling Payments from CMS | Article
Healthcare plans serving the Medicare market have two important challenges: successfully enrolling their members and making sure their reimbursements are accurate. Currently Infocrossing is the only supplier that has a contract with the Centers for Medicare and Medicaid Services (CMS), which allows it to handle both of those challenges.
Outsourcing saved Oregon $6 million the first year it outsourced a portion of its Medicaid program. The state’s return on investment: between $4.40-$4.80 for every dollar it sent to the supplier and healthier citizens.
A California hospital receives its payments by a capitation system which is not based on usage. Hospitals have to get the numbers right. So the hospital outsourced its data management to keep the red ink from flowing.
These days, many governments are changing their former approach to outsourcing, resulting in higher-value outcomes. Read about the foundational aspects and successful accomplishments of one such government outsourcing partnership.
Medicaid is one of the most controversial, complicated and expensive programs in U.S. government. It’s very political, so there is a high level of interest, and there is also a lot of change going on in it all the time, says Peggy Bartels, Administrator of the State of Wisconsin’s Division of Health Care Financing. So any entity that provides outsourcing for Medicaid is going to be in a fishbowl environment. It’s very difficult. She explains that the process of reviewing and making determinations about whether or not Medicaid will fund services is all done under the very close supervision and administration of the State. Decisions are controversial. By being our business partner, the outsourcer invites the same criticism we receive, she adds. They’re in the bull’s eye, and it is a big challenge to do that kind of work and maintain a positive presence. Nevertheless, EDS took the challenge and has been the Medicaid fiscal agent in the State of Wisconsin since their outsourcing agreement began in 1977.
Selecting a health care provider is tricky today because there are so many choices. To ensure the 1.8 million people enrolled in the Medicaid program in Texas have help in making that important decision, the Lone Star State decided to outsource that task, according to Larry Fisher, director, Contract Compliance division for the Texas Department of Health in Austin, Texas…