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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners.
This is an accepted version of this page This is the latest accepted revision, reviewed on 9 December 2024. Economic sector focused on health An insurance form with pills The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive ...
WfMS allows the user to define different workflows for different types of jobs or processes. For example, in a manufacturing setting, a design document might be automatically routed from a designer to a technical director to the production engineer. At each stage in the workflow, one individual or group is responsible for a specific task.
Under the HITECH Act, the United States Department of Health and Human Services (U.S. HHS) resolved to spend $25.9 billion to promote and expand the adoption of health information technology. [1] The Washington Post reported the inclusion of "as much as $36.5 billion in spending to create a nationwide network of electronic health records ."
The HIMSS Revenue Cycle Improvement Task Force was formed to prepare for the IT changes in the U.S. (e.g. the American Recovery and Reinvestment Act of 2009 (HITECH), Affordable Care Act, 5010 (electronic exchanges), ICD-10). An important change to the revenue cycle is the international classification of diseases (ICD) codes from 9 to 10.
In 2017, the new Republican healthcare bill known as the American Health Care Act was passed by the House of Representatives under President Donald Trump. Although the ACA and the American Health Care Act both propose tax cuts in order to make insurance more affordable for Americans, each of these bills affected Americans in different ways.
One factor perpetuating inefficiencies in health care is a lack of clarity regarding the cost of health insurance and who bears that cost, especially employment-based health insurance. Employers' payments for employment-based health insurance and nearly all payments by employees for that insurance are excluded from individual income and payroll ...