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Ingenix (United HealthCare Subsidiary) to Purchase CareMedic Services – Business Intelligence and Algorithms

Posted Nov 10 2009 10:01pm

Business Intelligence and analytics continues to grow in healthcare with mergers and acquisitions.  Just last week I posted about the Medical Banking image Project being acquired by HIMMS.  In looking at the CareMedic site, both are shown as affiliates.  Is the financial end of healthcare shifting to become the main focus today versus better healthcare?  Granted the 2 can work together but some sort of balance is needed for success I would think. 

HIMSS acquires Medical Banking Project – Business Intelligence and Banking Algorithms?

Just last week New York Attorney General Cuomo announced that a new data base will be created and maintained by a non profit organization replacing the one used by the insurance industry that was skewed and created additional out of network charges to be billed to patients.  The lawsuits are still coming on the data base and last week it rolled over into the car insurance business with a chiropractor bringing a case against Ingenix for default of contract in what they paid for injuries. 

It appears we might be looking at some additional “scoring” algorithms to be in place soon with the combined software efforts.  Algorithmic formulas both in healthcare and on Wall Street are getting more complicated by the day, so again I pose the question do we need to begin registering the formulas used as we do for the algorithms used in electronic medical records?  It’s just a rambling thought as a question as to why one side of the puzzle needs to be certified, but yet the other side does not.  BD 

“Department of Algorithms – Do We Need One of These Departments in the US Government?

Press Release:

Combined Business to Create Next-Generation Revenue Cycle Solutions, Improving Administration and Cash Flows for Hospitals and Health Systems  
Eden Prairie, Minn. and St. Petersburg, Fla., November 10, 2009 – Ingenix, a leading health information, technology and consulting company, today announced it will acquire CareMedic Systems, Inc., an industry leader in revenue cycle management (RCM) solutions for hospitals and health systems, in a cash transaction. 
With the acquisition of CareMedic, Ingenix will offer solutions that address each major component of the hospital revenue cycle: patient registration, eligibility verification, financial clearance, coding and compliance, bill submission, denials management, and remittance processing. Ingenix and CareMedic’s combined products and services will create a comprehensive suite of solutions for hospitals to manage the revenue cycle and improve financial performance – from the time a patient begins the registration process with a health care provider to the time payment for that care is received. This will be the industry’s only enterprise-wide solution that identifies inefficiencies as they occur, so clients can take practical actions to receive appropriate reimbursements and reduce costs throughout the process.
CareMedic provides hospitals with an enterprise platform of enabling technologies and services that optimize revenue cycle efficiency and improve cash flow, margins and productivity. CareMedic’s products and services include the Electronic Financial Record (eFR®) platform, which makes nearly real-time patient financial information accessible across departments within a hospital, helping clients take the right actions at every step of the revenue cycle to receive payments faster and more efficiently. With the eFR platform, CareMedic provides the industry’s most complete, historical view of a patient’s consolidated financial record with a provider organization. CareMedic’s capabilities will complement Ingenix’s coding and compliance expertise and automated credit balance resolution provided by its INTELLIJET® platform. CareMedic will also expand Ingenix’s existing Business Process Outsourcing (BPO) capabilities with patient financial management services, accounts receivable management, secondary billing and denials recovery, and other managed services offerings. CareMedic has contracts with more than 2,500 provider facilities across the U.S. and Puerto Rico.
Said Vince Schmitz, CFO of MultiCare Health System in Tacoma, WA, and client of CareMedic and Ingenix, “The combination of Ingenix and CareMedic is powerful and will bring many benefits to the industry. Being a long-time user of products and services from both companies has significantly increased our yield at MultiCare. I look forward to the innovation that the combined intellectual capital and resources of these two organizations can create.”
Bill Miller, executive vice president of Health Care Delivery at Ingenix, said, “With CareMedic, we will transform RCM from a group of fragmented, claims-centric processes to a more comprehensive, patient-centric financial information management system. The RCM systems available today lack interoperability between front-end and back-end functions, slowing cash flow and impeding a hospital’s ability to collect payment for services that have been provided. Our vision and combined capabilities will create a customizable enterprise-wide analytics solution for hospitals that seamlessly connects to other systems.”
Sheila Schweitzer, CEO of CareMedic, said, “With Ingenix’s expertise in reimbursement, health information management and consulting, and our expertise in enterprise-wide RCM, we will create a unified solution that makes hospitals more efficient at managing cash flow and enhances our commitment to helping clients get paid. As part of Ingenix, we will be able to provide clients with additional services and continued innovations that help them use capital more effectively and improve operational efficiency.”
Hospitals and health care systems are faced with increasingly complex and changing reimbursement rules and practices. According to the American Hospital Association, hospitals lost $65.9 billion in 2007 alone due to bad debt, uncompensated care and underpayment by commercial insurers and Medicare and Medicaid programs, while approximately 21% of U.S. hospitals had negative total margins. CareMedic addresses these pressures and has a track record with clients of helping to reduce or eliminate underpayment by Medicare and Medicaid.
Andy Slavitt, CEO of Ingenix, said, “Innovation and talent are key to solving health care's biggest challenges. We're combining the great teams at CareMedic and Ingenix to deliver innovation with the common vision of simplifying the system, reducing waste and centering health care around the patient.”
About Ingenix
Ingenix, a UnitedHealth Group (NYSE: UNH) company, is a leading provider of health information, technologies and consulting services. Organizations, institutions, businesses and government agencies that comprise the health care system depend on Ingenix solutions and insights to improve their performance. Visit www.ingenix.com for more information.
About CareMedic
CareMedic provides high value enterprise class solutions that streamline cash flow and speed the reimbursement process for hospitals and health systems, helping customers manage the complexity of the revenue cycle to increase their bottom lines. In 1997, CareMedic launched its flagship product, providing its customers with real-time direct entry to Medicare. Today, thousands of hospitals and providers depend on this real-time solution to manage their Medicare claims. More information about CareMedic can be obtained at http://www.caremedic.com.    

(RTTNews) -  Tuesday, Ingenix, one of Unitedhealth Group, Inc's. (UNH: News ) operating businesses, announced its decision to acquire CareMedic Services Inc., a revenue cycle management solutions provider, in a cash transaction. However, the deal amount or other details were not disclosed.
With the acquisition of CareMedic, Ingenix said it will offer better revenue cycle management, or RCM, solutions for patient registration, eligibility verification, financial clearance, coding and compliance, bill submission, denials management, and remittance processing. Ingenix and CareMedic's combined products and services include the Electronic Financial Record platform, which makes real-time patient financial information accessible across departments within a hospital.

RTTNews - Breaking News, financial breaking News, Positive EPS Surprises, Stock research ....

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