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Seth Flam, DO

Lead Blogger: Seth Flam, DO

Dr. Flam is one of the founders of HealthFusion and serves as the company's CEO and President. He is board certified in Family Practice and is one of the creative forces behind MediTouch EHR.

Will care quality suffer when insurance companies cut providers from network?

In a recent article, Medical Economics reports that UnitedHealth is cutting at least 15% of physicians from its Medicare Advantage plans. As one of the nation’s largest insurance companies, this means thousands of doctors, and their patients, are being directly affected by the cuts. “We are working to collaborate with a more focused network of physicians to help us provide higher quality and more affordable health care coverage to meet the needs of our members, and help them get more from their health plan benefits,” said UnitedHealth CEO Jack Larsen to the […] Continue Reading

Payment is Keyed to Coding — Practice makes perfect

Back in 2001 a prominent healthcare attorney, Alice G. Gosfield, stated, “Physicians need to listen up about the importance of proper coding… I understand that our coding system is not the easiest thing to learn. But look, [physicians] got A’s in organic chemistry, they can handle this.” And, as they learned in medical school, physicians need more than good grades to succeed. Understanding medical coding rules is now about to get more complex, as two new important coding systems will be impacting physicians in the next couple of years. It is the […] Continue Reading

5010 Update — How the Government and Blues have botched the 5010 claims transition (Where is my check, and how do I make payroll?)

History: Per The Centers for Medicare & Medicaid Services (CMS) website, on January 16, 2009, Health and Human Services (HHS) published two final rules to adopt updated HIPAA standards; in one rule, they officially adopted the X12 Version 5010 for claim submission and related transactions. They mandated compliance by January 1, 2012. CMS still states on their website that this 3 year timeframe, “gives the industry enough time to test the standards internally, to ensure that systems have been appropriately updated, and then to test between trading partners before the compliance date.” […] Continue Reading

EHR Vendors Can Lead the Way on Quality — Can we really wait for the government to innovate?

Many of the ways that EMRs relate to public health issues have been closely linked to government mandate, especially with the advent of Meaningful Use. Even before Meaningful Use, providers and EHR vendors were mostly in reaction mode, responding to the PQRS (formally PQRI) and the eRx (electronic prescribing) incentive programs. When I read the blogs of the large EHR vendors, I have noticed a persistent push-back on new regulations or requirements. Some of the resistance to follow the government’s lead is well deserved. There are at least 5 Meaningful Use Measures […] Continue Reading