Tag: CMS Update

Claims Management Automation Progresses, But Opportunities Remain

Providers and payers are increasingly adopting electronic claims management transactions, but remittance advice and prior authorizations are still largely manual. Electronic claims management adoption by plans and providers is at or above 80 percent for three of the seven transactions analyzed in the most recent CAQH Index. The CAQH 2018 Index showed adoption of fully electronic […]
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Payer, Provider Trends To Watch In 2019

Ripple effects from 2018 will continue well into the new year as players deal with some massive policy and business shifts. The coming year for healthcare will see the industry reckon with some of the massive changes set in motion last year, such as megamergers like CVS-Aetna and Cigna-Express Scripts and a judge’s declaration that the Affordable Care Act is no […]
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Four Ways RCM Must Transform for the Shift to Value-Based RCM

Value-based care is driving transformation of many established operations within medical groups—and the revenue cycle is no different. It is likely that 2018 will be remembered as the year that value-based care became a financial reality for most U.S. medical practices. Those participating in MIPS (the Merit-based Incentive Payment System) received their first round of […]
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Allzone - Revenue Cycle Resolutions

Revenue Cycle Resolutions

  It’s a new year! While your organization’s initiatives may not have changed when the ball dropped, you can be sure that your employees are feeling a burst of motivation as they start 2019, an eagerness to tackle the tough to-dos and an energy to learn, grow, and achieve. Perhaps you’re feeling it too! Let’s […]
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Beyond Benefit Design, Provider Billing Policies Hit Families Hardest

  What happens when record increases in health insurance premiums and deductibles put too much stress on patients’ pocketbooks? They delay needed care out of fear they’ll be unable to shoulder an unexpected medical expense for themselves or their families. Now more than ever, patients worry about their ability to cover out-of-pocket healthcare costs, a […]
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Medical Coding, Medical Billing, Denial Management, RCM

How Analytics Can Help Boost the Success of EHR Go-Lives

At HIMSS19, John Rekart, chief of quality management and informatics at the California Department of Corrections and Rehabilitation will show how homegrown analytics enabled a 25 percent post-implementation reduction in sentinel events. New electronic health record rollouts are infamously fraught with risk. At best, a they can cause workflow disruption, confusion among clinical staff and […]
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CO16 denial code

Non-Coverage Denials: Cause and Cure

Explanation of Medicare Benefits (EOB) error message 96 Non-covered charge was the No. 1 reason for claims denials in December in all of Medicare Jurisdiction H, according to the region’s Medicare Administrative Contractor (MAC). “Prior to performing or billing a service, ensure that the service is covered under Medicare,” Novitas Solutions says on their website. This should be […]
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Blockchain

HIT Think: How Blockchain Could Make an Impact In Healthcare

Blockchain, like other young and disruptive technologies, offers wide opportunities to impact healthcare, an industry that is primed for disruption. Despite being the largest sector of the U.S. economy, healthcare is plagued by slow systems, wasteful financing, and resource utilization and operational inefficiencies. To address these issues, innovative solutions like blockchain can alter the arithmetic […]
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Getting Paid In 2019

Navigating the reimbursement landscape can be confusing for physicians because of the number of entities that exert influence on payments. For example, CMS uses the Medicare Physician Fee Schedule (PFS) to adjust Medicare payments, and sometimes these changes can have dramatic effects on doctor pay. Coding changes reward some types of care while de-emphasizing others […]
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