Software controls on health costs

Article Abstract:

Health insurance companies are using complex software programs to keep track of doctors and their procedures and fees. These applications create profiles of the doctors and note which diagnostic tests or x-rays are ordered and whether these tests comply with the health coverage of the insurer. Many doctors oppose this new software because they believe that every patient deserves independent consideration and this software attempts to apply formulas to professional medical decisions. Metropolitan Life Insurance Co and Travelers Corp insurance companies use the software. One of the software vendors claims that 85 percent of the rejected claims are generated by 12 percent of the doctors monitored. Many vendors also claim that the software can help doctors by saving time spent on interviewing patients about their past medical history.

Life insurance, Health and allied services, not elsewhere classified, Computer software industry, Software industry, Software, Product information, Medical records, Travelers Corp., Metropolitan Life Insurance Co., Software Packages, Medical Diagnosis, Health Insurance

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Software helps patients make crucial choices

Article Abstract:

Software packages are helping medical patients better understand their maladies and decide whether they should opt for surgery. An interactive video disk system can provide real-life scenarios and specific detailed information about diseases through touch-activated screens and other modern technologies. A division of Sony Corp is marketing the patient-information systems with information about breast cancer, hypertension and lower back pain. Doctors and insurers favor the systems because patients will have obviously had ample opportunity to weigh the pluses and minuses of the medical care they received and will, therefore, be less likely to sue for malpractice. Some studies suggest that these interactive advice systems may actually improve recovery time using the placebo effect.

Innovations, Health care industry, Marketing, Sony Corp., Health care information services, Hospital information systems, New Product, Market Analysis, Marketing Strategy, Interactive Systems, Medical advice systems

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Insurers vs. doctors: a software battleground

Article Abstract:

Expert systems-based software is helping the insurance industry audit medical bills in order to weed out discrepancies and fraudulent charges. The products are usually created by small companies and can perform specialized tasks such as detecting bills that charge separately for procedures usually billed as one, check for unusually high or frequent charges, or help an insurer decide whether or not a patient needs surgery. Another segment of the software industry is marketing software to physicians and hospitals to help improve their revenues. These software packages help lower the number of rejected claims and maximize reimbursement.

Insurance industry, Technology application, Expert systems, Insurance claims adjustment

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