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The latest survey of 631 providers, payers, companies, and clearinghouses by the Healthcare Information and Management Systems Society (HIMSS) indicates that only half had completed testing for the Transaction and Code Standards (TCS), which standardized what information must be contained in electronic claims and how it should be transmitted.
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Health care is evolving, and managers must evolve with it, says Karen McKinley, RN, CHAM, vice president of patient access and care management for Geisinger Health System in Danville, PA.
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Where plaintiffs once focused entirely on the settlement amount, even when they had heartfelt grievances, todays plaintiffs are much more likely to demand that you change whatever they think led to their tragedies.
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When two medical tragedies struck Susan Sheridans family, one of her responses was typical and, most would say, entirely justified. She contacted an attorney and sued the health care providers for malpractice. But Sheridan took a different path from most plaintiffs by focusing more on quality improvement than the amount of money in the settlements.
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At Highmark Blue Cross Blue Shield, case managers are a vital component of the companys Dr. Dean Ornish Program for Reversing Heart Disease.
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The Dr. Dean Ornish Program for Reversing Heart Disease is a dramatic lifestyle change for most people who have coronary artery disease or are at risk for the condition.
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The case management department of Blue Cross and Blue Shield of Rhode Island has taken a unique approach to ensuring the physicians will collaborate with their case managers they pay them for their time.
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Centralizing all of its disease management programs has paid off for Aetna.
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When PacifiCare Health Systems Inc. decided to expand its disease management programs, the Cypress, CA-based insurer looked at all the options and decided to contract with vendors who were experts in their field rather than developing the comprehensive programs in-house.
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When it comes to disease management programs, Kathy Cartelli, director of disease management for PacifiCare Health Systems Inc. recommends hiring experts.