Facts on the Cost of Health Insurance and Health Care Part 1

August 26th, 2009 by admin

By several measures, health care spending continues to rise at a rapid rate and forcing businesses and families to cut back on operations and household expenses respectively.

In 2008, total national health expenditures were expected to rise 6.9 percent — two times the rate of inflation.1 Total spending was $2.4 TRILLION in 2007, or $7900 per person1. Total health care spending represented 17 percent of the gross domestic product (GDP).

U.S. health care spending is expected to increase at similar levels for the next decade reaching $4.3 TRILLION in 2017, or 20 percent of GDP.1

In 2008, employer health insurance premiums increased by 5.0 percent – two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,700. The annual premium for single coverage averaged over $4,700.2

Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect the security of families.

National Health Care Spending

  • In 2008, health care spending in the United States reached $2.4 trillion, and was projected to reach $3.1 trillion in 2012.1 Health care spending is projected to reach $4.3 trillion by 2016.1
  • Health care spending is 4.3 times the amount spent on national defense.3
  • In 2008, the United States will spend 17 percent of its gross domestic product (GDP) on health care. It is projected that the percentage will reach 20 percent by 2017.1
  • Although nearly 46 million Americans are uninsured, the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens.3
  • Health care spending accounted for 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France, according to the Organization for Economic Cooperation and Development.4

Posted in Uncategorized | No Comments »

Reviewing your auditing and monitoring functions

March 20th, 2009 by admin

The OIG recommends considering the following questions when reviewing the effectiveness of hospital and physician  auditing and monitoring. Is your facility performing the following functions?
Is the audit plan reevaluated semi-annual or annually?
Does it address the appropriate areas of concern, such as the findings from the previous years’ audits, risk areas identified as part of the annual risk assessment, and high-volume service?
Does the audit plan include an assessment of billing systems and billing personnel in addition to claims accuracy?
Are coding and audit personnel independent and qualified with the certifications?
Is the auditor or audit department available to conduct unscheduled reviews?
Is the compliance department able to request additional audits or monitoring?
If the error rates are not decreasing, have further investigations into other aspects of the medical facility compliance program to determine hidden weaknesses and deficiencies?
Does the audit include a review of all billing documentation, including clinical documentation, in support of the claim?

Posted in Uncategorized | 2 Comments »