Substance abuse coverage provided by employer medical plans

In summary, substance abuse is a serious problem in America. In fact, a Gallup poll ranked drug use as the Nation's number one problem. As a rapidly accelerating component of health care costs, charges for alcohol and drug abuse treatment are helping to drive up medical care expenses. The substance abuse crisis is also affecting employers, both public and private, who are struggling to provide needed health benefits while controlling spiraling plan costs. Despite the upward pressure on health costs, the problem is so serious that there has been a steady increase in the incidence of coverage for substance abuse treatment in employer-provided medical care plans, to the point that virtually all plans now provide some benefits. Nevertheless, health plans typically cover substance abuse treatment on a more restrictive basis than other illnesses. This may change, however, as the interest in, and the need for, comprehensive substance abuse treatment benefits grows.     

Electronic data interchange: a strategic approach

The potential of EDI is virtually unlimited, but the success of any EDI initiative hinges on its ability to directly support strategies that achieve your institution's business objectives. At its most fundamental level, EDI technology automates current business practices, speeding up the exchange of business information. This application of EDI most often is found in a hospital's material management department. But EDI integrated internally within a hospital and externally with suppliers and vendors has the potential to go beyond simple automation and to transform processes. This is where the full value of EDI can be realized. No matter which level of EDI participation hospital management decides is appropriate to fulfill its business objectives and strategies, EDI will affect the entire institution's exchange of information with its internal and external audiences. The question management must answer is: Will the hospital's EDI strategy be offensive and managed, or defensive and reactive? Today's environment leaves no room for a "no-strategy" EDI option. The options are either to proactively shape EDI, or reactively play catch-up. EDI can work for you. Adequately developing an EDI game plan in support of your business objectives and calling on your suppliers and other trading partners to work with you will ensure EDI is an asset to your facility.     

Practicing in a fish bowl

Intent on recovering "overpayments" to doctors, private insurers are turning to on-site practice audits. Here's a survival guide for these quasi-legal skirmishes.