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Sophisticated analytical tools help fuel successful disease management
IN THE 1980s and early 1990s, case management for patients with complex illnesses began evolving into the more specialized discipline of disease management. By the late 1990s, disease management was in widespread use, viewed as an effective way to help control swelling healthcare budgets while improving medical outcomes.
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Medicare Fraud: The OIG IS Watching
Identified through information uncovered during investigations, sudden upswings in Medicare claims and payments, and changes in the Medicare law or regulations, the OIG has targeted many different areas for investigation in 2004 to 2005.
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The Year Payers Stopped Threatening
Citing cherry-picked patients, unrealistic dosing, and
placebo control, payers will increasingly require that the proof for payment of drugs must come from head-to-head trials.
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USP's draft model formulary raises questions about guidelines
Although The U.S. Pharmacopeia's (USP) interim Medicare Prescription Drug Benefit Draft Model Guidelines recommend a drug classification system, CMS will consider other alternatives as long as the formularies provide preferred access to a broad range of widely used drugs.
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