5 Ways to Tackle an Appeals Backlog

by Jim Bobeck Government and commercial backlogs may occur quickly and without warning. A sudden spike of appeals can arise due to a seemingly innocuous change in government regulations. Adjustments to payment criteria for health services can send health plans, TPAs, ACOs, and PHOs into a claims tsunami. However, in most cases, backlogs mount gradually […]

Meltdown and Spectre

by Andrew Witchger The Issue While it might sound like the James Bond franchise just released a new movie, Meltdown and Spectre are the names given to two newly discovered methods to exploit critical vulnerabilities found in nearly every processor in circulation today. While major hacks in 2017, such as WannaCry, NotPetya, Bad Rabbit, targeted […]

ERISA External Reviews: Statutory Mandate for Legal Experts in Coverage Determinations

By Jim Bobeck As a law, ERISA is a complicated hodgepodge of many provisions regulating pension, health plans, and patient protections. Tucked away in paragraph (d)(2)(iii)(B)(1) of 45 CFR 147.136 is a seemingly innocuous provision that in summary states the following: Health insurance issuers (not just plans) must have an external appeals process where appeals are […]

Keep Calm and Carry On: Why Artificial Intelligence Is Not Going to Take Your Job

By Andrew Witchger   “Elon Musk’s Billion-Dollar Crusade to Stop the A.I. Apocalypse” “More than 70% of US fears robots taking over our lives, survey finds” “WILL AI TAKE OVER? ARTIFICIAL INTELLIGENCE WILL BEST HUMANS AT EVERYTHING BY 2060, EXPERTS SAY”   Headlines like theses seem to cover the front pages of major news publications […]

Medicaid: Serving All

By Lauren Bremer When it was first created in 1965, Medicaid was intended to insure low income individuals. Since then, it has grown vastly, now covering mental health, substance abuse programs, HIV treatments, children, pregnant women, and seniors—in total more than 75 million Americans. The U.S. government has tried to provide insurance to every American […]

5 Signs That You’re Not Truly Using Agile Methodology

By Andrew Witchger The daily stand ups are longer than 15 minutes. The idea of a daily stand up is for each team member to give a quick update about what they accomplished yesterday, what they hope to accomplish today, and any challenges they are facing in the development process. When the content of the […]

6 Thought Leaders You Should Already be Following on LinkedIn

By Lauren Bremer LinkedIn has become the place for healthcare professionals to network and stay current in thought leadership. To get started, here are six impactful LinkedIn accounts exploring the nexus of healthcare, technology, and government.   Brian Ahier: As the Digital Health Evangelist at Aetna, Ahier has been nationally recognized for his work with […]

AI in Healthcare Summit

With just over two weeks to go, FHAS is looking forward to the AI in Healthcare Summit. Join us in San Francisco to hear from industry thought leaders Keith Saunders and Andrew Witchger as they discuss “AI in Medical Claims Processing: Disrupting the Status Quo to Drive Better Payments and Patient Care.” Today’s advanced text […]
Posted in Cogno-Solve

Cogno-Solve as a means of “creative destruction”

By Keith Saunders In 2017, “disruption” has become a familiar buzzword in the world of business. Every new product or software release promises to be an industry disruptor, a promise to revolutionize the way business is done. Disruption to me implies a stand-still or an interruption in the normal flow of business, such as the […]
Posted in Cogno-Solve