Trends

Compliance with the Stark Law requires involving legal, compliance, and other expertise on the front end of the process rather than auditing for problems later.

In an attempt to build cooperative working relationships with physicians, some health plans are trying to reduce the burden of preauthorization.

New guidance highlights common questions that prosecutors ask when judging compliance program effectiveness.

The ACA prohibits discrimination in health programs or activities that receive federal financial assistance. Healthcare providers face the challenges of preventing language barriers that may impact certain patients based on race, as well as current litigation on gender identify.

Eligibility, outpatient medical necessity, and case management authorization continue to be three of the costliest denials. To avoid the negative effects of these types of denials, it is critical to implement an improvement process based on data.

The decision support team at Baptist Health implemented a new tool that provides dashboards to monitor service line performance, profitability, and utilization.

Understanding the efficacy of high-cost drug across large patient populations will help providers, payers, and pharmaceutical companies to understand the value of certain drugs and offer patients their life-saving value.

A hospital health information director shares three strategies to help organizations form an information governance structure.

To leverage its data assets toward population health management and other strategic goals, Children’s Health embarked on an information governance initiative that manages data throughout its lifecycle and organizationwide. 

Understanding the time commitment and negotiation strategies around direct-to-employer contracts are key areas for payment and reimbursement leaders to consider.