I worked with United Health Group/Ingenix on their billing/claims adjudification software, which delt with identifying and matching proceedures and modifiers, with contractual obligations, inorder to identify payment discrepencies.
Ingenix is the leading source of medical procedure codes and their modifiers. The issue we found with identifying and subsequently matching of procedures from providers, (hospital groups), and payers, (insurance companies), is that, (as was stated in an earlier post), most providers have their own codes and almost all payers have their own different codes. Also procedures are "bundled" in different means between the two organization types. Basically it's a complete mess in identifying a "lingua franca" for what is done to patients in hospitals and the subsequent billing issues. There are standards which are leading the way such as HIPPA/HICFA/Medicare. Along with all of this there is vested interest in NOT changing the system, as most contracts would have to be re-negotiated, which would cause risk to cash flows. So lots of reasons why things are not easy in US Health Care, some of the best solutions, (amazingly), seem to come from the US gov. Rich ________________________________________________________________ *Come to IxDA Interaction08 | Savannah* February 8-10, 2008 in Savannah, GA, USA Register today: http://interaction08.ixda.org/ ________________________________________________________________ Welcome to the Interaction Design Association (IxDA)! To post to this list ....... [EMAIL PROTECTED] Unsubscribe ................ http://gamma.ixda.org/unsubscribe List Guidelines ............ http://gamma.ixda.org/guidelines List Help .................. http://gamma.ixda.org/help
