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HEALTH CARE IS NOT BIG FOCUS IN PRESIDENTIAL ELECTIONS

By: Nicola Heredia, CHS Marketing Coordinator

At one time, Obamacare was a significant source of contention between the Republicans and Democrats. Although experts predicted that health care would play a big role in this year’s presidential elections, it appears that abolishing Obamacare or making changes to the new law is not the main priority of the candidates.

Instead of being critical about the existing health care laws, presidential hopefuls from both sides of the aisle are seemingly downplaying the actions that they would take if elected to the office.

“We all know that the Affordable Care Act or Obamacare was the big conversation in the past election cycle and now we’re in the wake of that,” says Dabney Evans, PhD, MPH, assistant professor of global health in the Rollins School of Public Health at Emory University in Atlanta, Georgia, in a Medical Economics’ article.

In a few short months, it will be time for the country as a whole to select the next President of the United States. Likely, there will be a transitional period as Americans adjust from the existing president to a new one.

Depending on who gets elected, there is a possibility that the country could face another major change when it comes to their health care. Although candidates may not be focusing as much on their stance on Obamacare, it is fair to say that the remaining individuals have strong ideas when it comes to the subject of health care in the U.S.

“On the Democratic side, I think we see [Hillary] Clinton sort of building on the Affordable Care Act. We see Bernie Sanders talking about more of a one-payer plan,” says Barbara Glickstein, co-director of the Center for Health, Media & Policy at Hunter College in New York City. “And on the Republican side, what we’re seeing is not answering the question.”

Take a look at some of the key facts when it comes to the remaining presidential candidates and their health care positions.

Republicans
Ted Cruz

  • Position on Obamacare: Repeal and replace Obama’s health care system with a new plan.
  • Summary of Health Care Plan: Individual Mandate would be removed and insurance plans would be allowed to sell coverage across state lines. This would create a much larger marketplace of insurance options for Americans.

John Kasich

  • Position on Obamacare: Repeal Obamacare and replace with new system.
  • Summary of Health Care Plan: New system should improve access to health care, which will ultimately lower costs. Kasich believes health care should revolve around quality instead of being a fee-for-service based system.

Donald Trump

  • Position on Obamacare: Replace ACA with market-based alternative.
  • Summary of Health Care Plan: Work with Congress to create a system with free market principles, allowing insurance companies to cross state lines. According to Trump, this will broaden access to health care and create true competition in the market.

Democrats
Hillary Clinton

  • Position on Obamacare: Keep ACA in place and build on groundwork to lowers costs.
  • Summary of Health Care Plan: Clinton is focusing on cost reduction in an effort to gain support. Specifically, she is narrowing in on rising prescription costs and out-of-pocket expenses.

Bernie Sanders

  • Position on Obamacare: Supports Obamacare as being the first step toward universal coverage.
  • Summary of Health Care Plan: Sanders believes that health care is a right and that all Americans should have access. His plan would center around the idea of having a single-payer health care system ran by the federal government.

Although health care may not be at the center of the elections as people originally thought, each candidate seems to have a clear viewpoint when it comes to how they would manage the current health care system if elected.

IDENTIFYING CLAIMS ERRORS IMPORTANT TO REDUCE IN LONG-TERM

By: Nicola Heredia, CHS Marketing Coordinator

When medical claim errors occur, it creates a problem that ends up having a costly solution. Although mistakes are a fact when it comes to relatively any job, these errors often times are avoidable on the part of both the payers and providers.

"What the payer wants from the provider is a clean claim," said Bruce Hallowell, managing director in the healthcare practice at Navigant Consulting, in a Healthcare Finance article. "If I submit a clean claim, I'll get paid in five days."

Providing what is considered to be a clean claim is more complex then it appears. Payers rely on physicians to provide enough documentation to make it possible to bill for the services.

Although simplistic in theory, the claims system becomes complicated when individual insurance companies have their own set of standards as to what is considered acceptable documentation from the providers.

“The errors that are being billed to the health-care payers, whether intentional or unintentional, are increasing due to the complex billing system,” says Pat Palmer, founder of Medical Billing Advocates of America in Roanoke, Va, in a Fox News’ article.

In 1982, there was a National Uniform Bill that created a billing form and set of standards to help guide physicians into providing correct information to facilitate accurate claims. Unfortunately, insurance companies have started to require different information, making it hard for providers to track what essential information is needed to correctly develop a claim.

"Payers don't understand why the hospital can't follow the basic rules," Hallowell said. "There's poor data quality from the provider and poor answers from the payer."

What may seem like a clean claim to one insurance company may have errors with another. The lack of a standard is one primary reason that claims get denied and bills go to patients incorrectly.

According to the Fox Business News’ article, hospitals have the same issues when it comes to developing clean claims. It is estimated that as many as eight out of 10 bills issued by hospitals contain some sort of errors.

"Hospitals, sometimes you get billed for things that never got done, medicines you never got and services not received," said Dr. Davis Liu, author of "The Thrifty Patient, in a NBC News' article.

When a hospital stay or physicians’ visit results in medical bills, claim errors will end up costing the insurance plan and/or the patient themselves. Unless the error is caught and rectified, someone along the chain will end up covering the added costs.

While there is not full proof plan to remove all claim errors, software companies continue to improve technologies used in an effort to catch mistakes before it is too late.

Errors can occur for a multitude of reasons. According to an article published on The Fiscal Times, there are five top reasons why claims do not get paid.

  • Charges are not covered under the patient’s policy
  • Referrals were required before the care was sought
  • Provider is not in the insurers’ selective network
  • An error occurred when entering information in electronically
  • Insurance company has been incorrectly billed

Patients will often see a rise in medical expenses, along with both providers and payers feeling the effects when it comes to processing inaccurate medical claims. Identifying the problems within the medical claims system is the first step to revising the system to reduce the costly effects of incorrect bills.

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