Eden Prairie, Minn.-based Ingenix, a health information technology and services company, today announced it is acquiring Newtown Square, Pa.-based Executive Health Resources, a provider of medical necessity compliance and physician medical management solutions for hospitals. The transaction is subject to regulatory approval and other customary closing conditions and is expected to close before the end of 2010. This comes a month after Ingenix announced its acquisition of Wakefield, Mass.-based Picis Inc., a provider of health information solutions for the high-acuity areas of hospitals.
Combined, Executive Health Resources and Ingenix will have a greater ability to help hospitals manage medical necessity compliance requirements as hospitals and health systems serve an increasing volume of patients with government-sponsored health benefit plans. Executive Health Resources’ Physician Advisor teams provide hospitals and health systems with the dedicated, technology-supported services needed to assist hospitals with managing compliance with Centers for Medicare & Medicaid Services (CMS)- and state-directed medical necessity rules and regulations. Ingenix offers consulting, information systems and services that help hospitals maintain the quality of care and improve operational efficiency.
Under federal and state law, hospitals and health systems must perform compliance reviews for medical services provided to patients covered by Medicare and Medicaid programs to ensure that care is medically necessary and delivered in the proper care setting. Congress expanded federal auditing oversight in 2006 to all 50 U.S. states in an effort to reduce federal payment discrepancies with hospitals. Executive Health Resources provides evidence-based clinical intelligence and Physician Advisors highly-trained in CMS rules and regulations to support hospitals in complying with federal and state provisions related to medical necessity.