Learn about the health insurance market and provider billing, including recent trends and developments. Topics will include:
-Overview of the health insurance market with recent trends for claims payment practices and healthcare provider billing.
-Impact of recent healthcare reform addressing fraud and technology on provider billing and insurance claims reimbursement.
-Discussion of transparency issues in healthcare with focus, including understanding discounts and rebates when contracting for healthcare and pharmacy benefits.
-Insights for auditing and potential changes in health insurance plan administration to consider for fully insured and self-funded plans.
This session will include examples of healthcare claims and market data to be used for educational purposes to highlight trends in the insurance industry. It will also highlight opportunities to enforce existing laws around fraud and abuse, and areas for regulators and legislators to focus to address this growing problem. Finally, it will discuss recent law changes and highlight areas requiring additional regulatory intervention. Expect discussions of recent claim issues and laws in the healthcare market as well as emerging issues in healthcare.
The presentation will be beneficial to healthcare professionals working for health insurers, healthcare providers, auditors, regulators and healthcare providers and will also cover professionalism related topics for actuaries.