Clean Sweep Live Auction on Wed. February 27th. Click to view the full inventory

DOTmed Home MRI Oncology Ultrasound Molecular Imaging X-Ray Cardiology Health IT Business Affairs
News Home Parts & Service Operating Room CT Women's Health Proton Therapy Endoscopy HTMs Mobile Imaging
Aktueller Standort:
> This Story

starstarstarstarstar (1)
Log in oder Register to rate this News Story
Forward Printable StoryPrint Comment




Artificial Intelligence Homepage

Women's brains appear three years younger than men's at the same age: PET study A machine-learning algorithm assisted with the analysis

AI and personalized medicine to raise the bar in radiology reporting New innovations could provide myriad benefits to clinical workflow

Hologic launches Unifi Analytics to curb mammo downtime Predicting tube failures before they happen and setting performance benchmarks

Pediatric imaging AI aces elbow fracture diagnosis Reading rare pathology still presents challenges

Making the invisible visible: The future of AI in imaging Insights from Steve Tolle, vice president of global strategy and business development for IBM Watson Health

Siemens focuses on digitalization at HIMSS Its expanded digital service portfolio will be on display

Frost & Sullivan outline 10 growth factors for precision imaging market Market predicted to be more than $8 billion by 2027

2018 capital investments hit nearly $580 million for AI providers in medical imaging Shift from early- to late-stage investments

Prestige Medical Imaging partners with Esaote and Glassbeam Expands portfolio to include MR, ultrasound and analytical software

Medic Vision to deploy iQMR in China through new partnership with KAME Address extreme overload of imaging requests in China

How artificial intelligence can transform payment integrity

By Krithika Srivats

In 2013, the actress Angelina Jolie published an opinion column in the New York Times that described her decision to undergo a preventive mastectomy after testing positive for the BRCA gene, a mutation that can lead to breast cancer.

Within two weeks of the column’s publication, more than 4,500 BRCA tests were ordered across the nation, a 64 percent rise from the same time period the previous year. Interestingly, researchers found no increase in the number of breast cancer diagnoses, and mastectomy rates actually declined. This suggested that many of the tests were given to populations at low-risk of carrying the mutation. In the end, a few hundred words written by a celebrity cost the healthcare system nearly $14 million for tests that were largely unnecessary.
Story Continues Below Advertisement

Servicing GE Nuclear Medicine equipment with OEM trained engineers

We offer full service contracts, PM contracts, rapid response, time and material,camera relocation. Nuclear medicine equipment service provider since 1975. Click or call now for more information 800 96 NUMED

Though this was a clear example of overutilization, the payment integrity programs of most health plans mounted responses that were either ineffective or non-existent. A closer look at most payment integrity programs reveal why they were ill-suited to the task.

While specific components of a payment integrity program can vary among health plans, most include a combination of human-based review and rules-based automation software to identify anomalies among thousands of claims. However, manually-driven payment integrity programs – even those augmented with automation and analytics software – identify less than half of all claims anomalies, which may or may not prove to be improper claims after further investigation. In addition, this resource-intensive and costly process was largely built on a pay-and-chase model, whereby outliers are targeted and recovery of previous paid claims are initiated.

A 2018 Gartner report, “U.S. Healthcare Payer CIOs Must Adopt Prospective Payment Integrity to Thwart Improper Claims Payment and Fraud,” concluded that health plan executives can significantly improve the financial returns from payment integrity programs” through prospective processes and “exponentially increase financial performance and improve provider relationships.”

Fortunately, technological advances have given health plans an opportunity to build a better payment integrity system – one that doesn’t just anticipate emerging trends from, say, a high-profile endorsement of an expensive medical test, but most other forms of overutilization.

The solution? Artificial intelligence (AI).

AI has been successfully applied in many areas of healthcare with proven results – from the creation of better care pathways to advances in disease research and reducing medical errors. AI also has the potential to be a significantly more reliable, efficient, and cost-effective solution to mitigate improper claims payments that cost the healthcare industry hundreds of billions of dollars every year.
  Pages: 1 - 2 - 3 - 4 >>

Artificial Intelligence Homepage

You Must Be Logged In To Post A Comment

Erhöhen Sie Ihren Bekanntheitsgrad
Auktionen + Privatverkäufe
Den besten Preis erzielen
Geräte/Geräteteile kaufen
Den günstigsten Preis finden
Daily News
Die neuesten Nachrichten lesen
Alle DOTmed Benutzer durchsuchen
Ethik auf DOTmed
Unseren Ethik-Standard anzeigen
Gold-Parts Verkäufer-Programm
PH-Anfragen erhalten
Gold Service Dealer-Programm
Anfragen empfangen
Alle Gesundheitsdienstleister-Tools anzeigen
Einen Job suchen
Parts Hunter +EasyPay
Angebote für Geräteteile erhalten
Kürzlich zertifiziert
Kürzlich zertifizierte Benutzer anzeigen
Kürzlich bewertet
Kürzlich zertifizierte Benutzer anzeigen
Rental Central
Geräte billiger mieten
Geräte/Geräteteile verkaufen
Das meiste Geld erhalten
Service-Techniker Forum
Hilfe und Beratung finden
Einfache Angebots-Anfrage
Angebote für Geräte erhalten
Virtuelle Messe
Service für Geräte finden
Access and use of this site is subject to the terms and conditions of our LEGAL NOTICE & PRIVACY NOTICE
Property of and Proprietary to DOTmed.com, Inc. Copyright ©2001-2019 DOTmed.com, Inc.