Reimbursement

Although healthcare reform dominates the payer world, payers need to start working on a game plan for the major transition to ICD-10, industry consultants said. "The biggest mistake payers can make is not addressing the impact assessment quickly," said Pamela Ruebelmann, vice president of healthcare solutions for HighPoint Solutions. An assessment, which provides a full understanding of all the impacted components of people, process and technology, will help payers develop a multi-year, organization-wide roadmap, she said.

In an effort to boost healthcare delivery, physicians at Children's Hospital Boston are partnering with Massachusetts' major health plans to develop new technologies and integrated care models.

The Centers for Medicare and Medicaid Services has announced a 2 percent market basket update to Medicare's calendar year 2010 home health prospective payment system rates and modifications to the home health outlier policy.

The U.S. Department of Health and Human Services has issued an interim final rule to strengthen enforcement and increase penalties for violations of the Health Insurance Portability and Accountability Act, known as HIPAA. The Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009, modified the penalties that the HHS could impose for violations of the HIPAA rules.

Key changes to physician quality reporting and e-prescribing incentives are being proposed by the Centers for Medicare and Medicaid.

Thanks to almost $100 million in settlement proceeds from health insurers, a new reimbursement database for out-of-network healthcare charges is being developed in New York.

A regional not-for-profit health insurer serving New York, Vermont and New Hampshire will reimburse physicians for online consults.

Horizon Blue Cross Blue Shield of New Jersey has deployed a new Web-based portal to use as its health information exchange platform. The new multi-layer Web portal, developed by Cambridge, Mass.-based NaviNet, will be used to assist Horizon BCBSNJ in reducing paperwork, simplifying administrative processes and reducing expenses with electronic exchange of health data.

Ezekiel Emanuel, a White House adviser on healthcare policy, says high-touch is the way to fix the nation's failing – and costly – healthcare system.

A new initiative launched in Ohio plans to improve the flow of information between health plans and physicians' offices using a multi-payer Web portal.