In reading this article, this is what is happening now as folks are calling in the “consultants” who they have to pay to teach the doctors,
nurses and others on staff how to document so claims are paid correctly and promptly. Who pays for this, the hospitals, so one more expense coming on board for many hospitals that are already financially strapped. This is kind of a catch 22 item as if they don’t invest they run the gambit of lower compensation and on the other hand they also look to make sure the hospital is not over charging. You wonder sometimes when you read about all these “fines” that hospitals pay for billing errors, is the hospitals no coding right or is it the software and lack of education rolled in there? Sure there are the obvious cases but each case is it’s own. You can even buy a shirt that says don’t bother me, I’m coding.
Some insurance companies, like United Healthcare also created their own clearinghouse subsidiary to audit the bills before they are sent on. Most providers today do use some type of clearinghouse to check their work for accuracy and with a clearinghouse subsidiary it’s a bigger piece of the pie for overall corporate revenues as this subsidiary servers to generate revenue by subscriptions whereby the hospitals pay for this service, so they could end up with 2 legs of the process here with medical billing with clearinghouse services subsidiaries that check for accuracy before it hits their claims processing. United has so many subsidiaries anyway though and have recently hired former Minnesota Assistant Attorney General as general counsel as well as hiring the former HHS executive created most of the provisions of the healthcare law.
OptumInsight (A Wholly Owned Subsidiary of United HealthCare Optum Division) Creates Medical Clearinghouse Integrated With Epic Practice Management Software-Subsidiary Watch
US Health Insurance Regulator Leaving to Take a Job at UnitedHealth Care As Vice President of the Optum Division – Moving to the “For Profit Side” With Business Intelligence Algorithm Dollars To Review
Meanwhile back at the ranch, HHS Secretary Sebelius is counting on algorithms only while the powerful folks formerly 
in government leave and move over to the “for profit” side and they will have an advantage for sure at United as these folks bring with them knowledge as to how the government operates or doesn’t operate on the other side. This kind of reminds me of the PBS 4 part documentary to where they spoke with former brokers who made a lot of money and they all admitted they were given the tasks to “find loopholes” so they could make even more money. Watch this PBS 4 part video series on Wall Street
HHS Secretary Sebelius Still Looking for Tech Breakthroughs To Save the Day
So the long and short of this is more training of doctors and nurses with additional expenditures to create faster claim processing for the hospitals while the bottom line of insurers’ subsidiaries continues to grow. No wonder medical records are taking on a new reputation as they are now being created for the benefits of compensation rather than clinical care.
There was an article on the web this week that more doctors are using electronic medical records and liking it less, and this kind of tells the story why as now we have yet one more layer of expertise to use and pay for to make all of this happen, and the payers benefit, not so much the patients for the most part. BD
When it comes to patients getting an error-free medical bill, the name of the game for doctors and hospitals is documentation.
That's because if the care isn't recorded and well-documented while it's being provided, insurance companies and federal payers will ask for more information later. Payment for services slows down, and chances for mistakes skyrocket.
That can mean checking that seemingly obvious details are recorded. For instance, each time a nurse starts an IV, she must write it down because there is a charge for the equipment used, Bauschka explained.
That chart -- whether it is electronic or paper -- is also key for the coders, who translate the care documented on the chart into billable codes, said Kathy DeVault, director of professional practice at the national industry organization American Health Information Management Association.
Many health systems and doctors' offices struggle with documentation because of a lack of staff training, DeVault said, adding that "what seems very simple from the outside looking in, is very complex."
http://www.cleveland.com/healthfit/index.ssf/2012/06/many_providers_turn_paperwork.html
ethically doing business, but as you read in the news, we are all of sudden finding a entire slew of folks who are not, surprised? You shouldn’t be as this has been going on a long time but as folks getter smarter about the methodologies that have been used for a number of years, it’s all coming out. Sure someone can like their business algorithms but if ethics are compromised in the act then what do we have? Maybe I should ask someone on Wall Street about that while I’m at it. What started all of this..a stolen notebook that shows their lack of ethics and HIPAA violations. 
but nine notebooks were stolen so nine times the potential exposure possibly, depending on what they were carrying around. The Vice President of the company left a non encrypted laptop with around 24k patients' information on the computer, gee and we wonder why executives are kind of useless today, but you could almost be he preaches to employees NOT to do this:) This was also Chapter 28 of my Attack of the Killer Algorithm series. 
Sometimes it’s interesting to take a look at what’s happening in other countries relative to the rising cost of healthcare and when you read this it’s apparent that this is not only an US problem. Granted Israel is a much smaller country but the problem are the same, money or lack of. Just a couple months ago, doctors who work for the state received an order that they needed to punch a time clock. How would that work in the US…I don’t think it would accomplish much here. 
a former software writer, hopefully some of this will explain in layman’s terms how some of this works behind the scenes it may offer some answers. It’s not going to make you happy but it will open your eyes as to how the world of technology functions today with decision making and perhaps give you an idea of where it’s headed too.
Math–This Could be a Subject for Michael Moore to Explore and Document In a Movie
Screenings Too–Killer Algorithms Part 12–Medical Billing Codes Style
Assessing Consumer Credit Scores–Attack of the Killer Algorithms Chapter 21 With Flawed Data
awareness and how we and our government moves forward with this reality, it remains to be seen if we can scoot around the big white elephant in the living room that nobody can see, touch or talk to <grin> but it roars. Richard Cordray has his work cut out for him and that is an understatement. 
the news with older policies being cancelled and new ones written. Some may accomplish this via marketing efforts and the old policy rates go out of reach as far as being able to afford so consumers are kind of forced to make a decision at that point. Those with pre-existing conditions sometimes can’t switch to a policy that is comparable or better and thus are trapped to take what they can afford and have to abandon their original policies as they can’t afford the premiums any longer. 
the data reported was not accurate either, so why have it. I’m sure it’s getting better as time moves on but I glanced through the list and guess what, not one hospital in Massachusetts was listed? What’s up with that. It might have something to do with the hospitals in that state contesting how Health Grades came up with their numbers, and they are right to question. 
pay rent, bills, etc. As I have mentioned before on a few occasions, the middle class and I should add retirees are just becoming “data chasers”. Was it his fault this mistake was made? No, but this “bad” consumer at the mercy of a retirement “algorithmic error” is going to pay the price…how analytics looks at us humans at times as we have very few folks that ethically know how to work with “flawed data” and this is a classic case. Punish that “bad” consumer who on a couple occasions risked his life doing his job! 
errors are being caught and again it was not due to any of the information entered by the retiree, it’s the system finding errors within and incriminating the retiree, which all of this is not his fault and is purely one more example of the “Attack of the Killer Algorithms. His case is not alone as we see businesses and others doing the same thing and where’ the ethics here? When numbers and profit enter the picture folks who lack balance and accountability for “their” errors make the consumers the “bad guy”. 
“desired” results, they should also be held accountable for their accuracy and we don’t’ have much of this as lawmakers and others, including bank executives sit in denial or kind of play dumb and it gets reported in the news as yet one more OMG story, but nobody digs to the bottom to find the “cause”. Maybe I was ahead of myself here, but back in August of 2009 I asked the question, “do we need a department of algorithms” when the Madoff case was discovered. He even figured out how to “fake” algorithms” he never had and created his Ponzi scheme based on the naïve nature on which lawmakers react today and look at the people who were hurt there. 
released from his sentence a smart judge through it out and I myself questioned the bulls run he received with his court case. I’m not saying he was innocent or guilty but the dog and pony show done by Goldman played on the lack of education with high tech data today and again, luckily a judge finally came to terms with this and saw it for what it was and over turned the conviction. You can’t get a jury of peers today with some of the very complicated algorithms we have working today just about. 
As the the article states here he was the one responsible for enacting the US insurance regulations created by the healthcare overhaul. Now I am guessing that he is on the other side of the fence and being he has the first hand knowledge of all that was written in to law, perhaps a priority here could be to find the “loop holes” in the law when working on the private side. This is is nothing new as that’s what happens usually when one moves to the other side. About a year ago the Health Insurance Exchange Chief left HHS and Mr. Larsen was the spokesperson making the announcement. 
overhaul, said he is leaving to take a job with UnitedHealth Group Inc. (UNH) (
to choose Office 365. In addition this makes more room for using Share Point for collaboration efforts as well as having video and other capabilities that are built into Office 365. If you ever had to monitor and take care of Exchange on a client/server operation, then you will appreciate cloud services for sure. 
…and we know the rest of that story…Killer Algorithms attack once again. CEO was less than knowledgeable and again just one more of those high paid figureheads today out there running around with little tech knowledge. If I were a software engineer at Facebook, I would be pretty angry and not to mention inquisitive too as what happened with those algos as they write and test enough of their own.