Ingenix looks to medical necessity as next venture
Ingenix, a health IT and services company, has acquired Executive Health Resources, a developer of medical necessity compliance and physician medical management technologies for hospitals.
According to Eden Prairie, Minn.-based Ingenix, Executive Health Resources’ physician advisor teams provide hospitals and health systems with technology-supported services that assist hospitals in managing necessity compliance with Centers for Medicare & Medicaid Services- and state-directed medical necessity rules and regulations. Executive Health Resources serves more than 1,100 hospital and health system clients, which include for-profit and non-profit systems, academic medical centers, community hospitals and specialty centers.
This transaction comes on the heels of Ingenix's late-July purchase of Picis, a developer of health IT for hospital emergency, surgery and intensive-care departments and hospital financial information systems.
Last year, Ingenix settled its alleged healthcare fraud charges. In January 2009, UnitedHealth offered a $50 million settlement with N.Y. Attorney General Andrew M. Cuomo, to overhaul two of its databases used to determine out-of-network reimbursement amounts for certain health plan members. As part of the settlement, UnitedHealth agreed to fund a nonprofit entity to develop and own a new, independent database to replace Ingenix’ Prevailing Health Charges System and Medical Data Research databases, which are used by health plans and employers to determine the reimbursement rates to members who receive physician services outside their managed care network.
Since that time, Ingenix acquired AIM Healthcare Services, and its affiliated companies, Netwerkes and Ingram & Associates, which provide billing technologies for U.S. healthcare payor and hospital clients in July 2009. Then, in November 2009, Ingenix bought CareMedic Services, which offers applications for patient registration, financial clearance, coding and compliance, bill submission, denials management and the remittance processing components of the hospital revenue cycle.
The Executive Health Resources’ transaction is subject to regulatory approval and other customary closing conditions, but Ingenix expects it to close before the end of the year.
According to Eden Prairie, Minn.-based Ingenix, Executive Health Resources’ physician advisor teams provide hospitals and health systems with technology-supported services that assist hospitals in managing necessity compliance with Centers for Medicare & Medicaid Services- and state-directed medical necessity rules and regulations. Executive Health Resources serves more than 1,100 hospital and health system clients, which include for-profit and non-profit systems, academic medical centers, community hospitals and specialty centers.
This transaction comes on the heels of Ingenix's late-July purchase of Picis, a developer of health IT for hospital emergency, surgery and intensive-care departments and hospital financial information systems.
Last year, Ingenix settled its alleged healthcare fraud charges. In January 2009, UnitedHealth offered a $50 million settlement with N.Y. Attorney General Andrew M. Cuomo, to overhaul two of its databases used to determine out-of-network reimbursement amounts for certain health plan members. As part of the settlement, UnitedHealth agreed to fund a nonprofit entity to develop and own a new, independent database to replace Ingenix’ Prevailing Health Charges System and Medical Data Research databases, which are used by health plans and employers to determine the reimbursement rates to members who receive physician services outside their managed care network.
Since that time, Ingenix acquired AIM Healthcare Services, and its affiliated companies, Netwerkes and Ingram & Associates, which provide billing technologies for U.S. healthcare payor and hospital clients in July 2009. Then, in November 2009, Ingenix bought CareMedic Services, which offers applications for patient registration, financial clearance, coding and compliance, bill submission, denials management and the remittance processing components of the hospital revenue cycle.
The Executive Health Resources’ transaction is subject to regulatory approval and other customary closing conditions, but Ingenix expects it to close before the end of the year.