Here’s a familiar topic on the Medical Quack that’s been going on for a couple years, algorithms and audit trails to be specific. We go through all the trouble to “certify” electronic medical records to ensure their accuracy and ability to provide the correct information, but nobody does that on the other side of the coin, which if that side doesn’t work first then there’s no money for the other side. Should we certify the health insurance payment algorithms used?
Instead of waiting and going back and forth, if audits were electronically conducted on certain areas of the business then perhaps we wouldn’t have this back and forth action that takes up time for everyone.
Here’s a post from a couple months ago where the hospital, the peer groups and utilization couldn’t understand how their payments were calculated either. What's up with this when such a big question hovers? Its is any wonder hospitals have issues with their budgets when confusion of this sort occurs?
Also I’m just curious as to what are the “oversight processes” in place at other Wellpoint locations? What numbers are used to calculate and are they correct and not like the Ingenix data base that was used for 15 years that was found to be corrupt when it came to paying doctors and patients? BD
The Obama administration's top health official is urging state regulators and lawmakers to investigate whether WellPoint Inc. made mathematical errors in justifying sharp rate increases around the country.
In a letter being sent to state insurance commissioners and governors late Tuesday, Health and Human Services Secretary Kathleen Sebelius calls for a national inquiry into the data underpinning rising health-insurance costs. Ms. Sebelius is seizing on WellPoint's decision last week to withdraw a request for up to a 39% price increases on individual plans in California after an actuary hired by the state found several mistakes in the filing.
WellPoint has become a lightening rod for criticism over rising premiums. Chief Executive Angela Braly was called before Congress in February to defend its California rate increases. At that hearing, Ms. Braly pointed to mushrooming charges by hospitals, doctors and drug companies that are passed through to consumers in their insurance bills.
WellPoint said both New York and Connecticut have rate oversight processes in place to double-check the actuarial assumptions in companies' filings.
The issue extends beyond WellPoint, which is hardly the only insurer to request big rate increases.