Tracking electronic claims growth

Providers are submitting a growing majority of claims electronically. But physicians trail hospitals and pharmacies in the use of EDI.     

1995--a healthy year for electronic claims growth

Electronic claims processing is coming of age. nearly half of the more than 3.6 billion claims providers submitted during 1995 were transmitted electronically. Providers submitted an estimated 47% of all claims electronically last year, compared to 41.5% in 1994.     

Electronic health records vs Medicaid claims: completeness of diabetes preventive care data in community health centers

PURPOSE Electronic Health Record (EHR) databases in community health centers (CHCs) present new opportunities for quality improvement, comparative effectiveness, and health policy research. We aimed (1) to create individual-level linkages between EHR data from a network of CHCs and Medicaid claims from 2005 through 2007; (2) to examine congruence between these data sources; and (3) to identify sociodemographic characteristics associated with documentation of services in one data set vs the other.METHODS We studied receipt of preventive services among established diabetic patients in 50 Oregon CHCs who had ever been enrolled in Medicaid (N = 2,103). We determined which services were documented in EHR data vs in Medicaid claims data, and we described the sociodemographic characteristics associated with these documentation patterns.RESULTS In 2007, the following services were documented in Medicaid claims but not the EHR: 11.6% of total cholesterol screenings received, 7.0% of total influenza vaccinations, 10.5% of nephropathy screenings, and 8.8% of tests for glycated hemoglobin (HbA_1c). In contrast, the following services were documented in the EHR but not in Medicaid claims: 49.3% of cholesterol screenings, 50.4% of influenza vaccinations, 50.1% of nephropathy screenings, and 48.4% of HbA_1c tests. Patients who were older, male, Spanish-speaking, above the federal poverty level, or who had discontinuous insurance were more likely to have services documented in the EHR but not in the Medicaid claims data.CONCLUSIONS Networked EHRs provide new opportunities for obtaining more comprehensive data regarding health services received, especially among populations who are discontinuously insured. Relying solely on Medicaid claims data is likely to substantially underestimate the quality of care.     

Protection against employment claims

Risk managers already deal with a great many issues in today's complex, managed-care driven, healthcare environment. Now they must add expertise in handling ever more complicated employment issues. This article addresses areas risk managers need to both know and understand concerning this area of law, and some steps they can take to minimize loss or provide for insurance protection for any loss.     

Health claims and functional foods

Australia and New Zealand are currently preparing a new food standard, which will allow the use of health claims for functional foods. The aims of this study were to summarise current regulatory proposals and to review recent research from the National Centre of Excellence in Functional Foods on the use and understanding of health claims. All relevant publications from the National Centre of Excellence in Functional Foods, cited in the annual reports from 2003 to 2007, were reviewed and summarised. Five publications have reported surveys of the use of health claims on food labels, in magazine advertising and on the Internet. High-level claims that do not comply with current food regulations are being used, particularly in advertising. Both dietitians and marketing experts agree that many of the claims currently used are potentially misleading. Focus group studies have shown that consumers are interested in health claims but are sceptical about their reliability from manufacturers without strong regulation. Experimental studies show that the format of claims, and the food on which they are carried, influence consumer acceptance. Many factors other than the actual words used in health claims influence consumer purchase decisions. However, current research indicates that claims can improve understanding of the benefits of functional foods and potentially support healthier food choices.