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Related Experiment Videos

Information technology boosts managed care's 'bottom line'.

C M Wright1

  • 1Healthcap Management Group, Inc.

Computers in Healthcare
|June 7, 1993
PubMed
Summary
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Managed care organizations often overpay for procedures due to billing errors. Implementing better information systems can prevent these costly mistakes and improve financial oversight.

Area of Science:

  • Healthcare Administration
  • Health Informatics
  • Medical Billing

Background:

  • Physicians, clinics, and hospitals affiliated with managed care organizations (MCOs) frequently incur costs for procedures that should be classified as shared risk.
  • This results in significant financial losses for healthcare providers and MCOs due to improper billing practices.

Purpose of the Study:

  • To highlight the financial burden of incorrect billing practices within managed care.
  • To emphasize the potential of information systems in mitigating these financial losses.

Main Methods:

  • Analysis of billing data within managed care settings.
  • Identification of common billing errors related to shared risk procedures.

Main Results:

Related Experiment Videos

  • Significant financial losses are incurred by providers and MCOs due to misclassified procedures.
  • Information systems, when properly configured, can identify and prevent these billing errors.

Conclusions:

  • Healthcare organizations must adopt robust information systems to accurately capture billing information.
  • Implementing advanced systems can lead to substantial cost savings by preventing improper payments for shared risk procedures.