Tag: Healthcare Claims

claims-payment-transformation-benefits-payer-providers-and-members

Claims Payment Transformation Benefits Payer, Providers, and Members

Payers, providers, and members can all benefit from transforming the manual and patchwork claims payment process to a digital environment that also automates claims data delivery. Payers, providers, and members are all central to the healthcare experience, working together to create a seamless, coordinated encounter from registration and the clinical visit to claims payment and […]
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Optum partners with SSM Health and will employ certain revenue cycle staff

To reduce care variation, SSM and Optum will use clinical technologies, advanced analytic and data-driven insights at the point of care. Certain SSM Health revenue cycle staff and hospital care management will become employees of Optum. They will continue to work in their current locations across Illinois, Missouri, Oklahoma and Wisconsin. WHY THIS MATTERS As […]
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RCM Automation for AR Efficiency

RCM Automation Boosts Practice’s Accounts Receivable Efficiency

  Days in accounts receivable (A/R) is one of the most important key performance indicators for growing practices. In an increasingly complex healthcare environment—and one in which financial responsibility is shifting to the patient—keeping track of how long it takes to collect healthcare revenue that a practice has billed but has yet to receive from payers […]
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MSP Billing Rules

CMS Issues Reminder on MSP Billing Rules, Appeal Options

  CMS is reminding organizations of Medicare Secondary Payer (MSP) billing and appeal processes after the agency inappropriately denied some claims. Organizations are advised that they must continue to provide services to patients who have open or closed secondary payer records on file or if Medicare inappropriately denied a claim, according to MLN Matters SE21002. Organizations are […]
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Healthcare Automation

Advancements in Automation Are Cutting Into the Rising Costs of Manual Healthcare Transactions

Inefficiency is an issue that continues to plague many areas of healthcare, particularly when it comes to manual administrative functions. While the industry is increasingly harnessing technology – evidenced by the use of telehealth and the push for electronic health record interoperability – administrative complexity continues to be burdensome, and largely paper- and fax-driven. This […]
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AI difference in Healthcare

The AI Difference in Revenue Cycle Management

Effective Revenue Cycle Management (RCM) is non-negotiable for all health care practices, but despite this, clinics across the board are reporting increasing levels of dissatisfaction with their current RCM tools. According to a 2019 KLAS report, more than one-third of the 140 respondents to their RCM survey said they wouldn’t purchase their vendor’s services again, […]
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Medicare Advantage Plans

Medicare Advantage Plans Could See Payments Drop in 2021 Due To Covid-19, Analysis Finds

  The COVID-19 outbreak appears to have impacted claims patterns for Medicare Advantage enrollees, according to a new analysis by Avalere Health. Even though seniors are historically the most vulnerable population health-wise, their claims were down dramatically during the month of April. The survey suggests it could impact risk score factors for MA plans in 2021, driving […]
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Claim Denials

Root Causes Linked to Claim Denials

Three revenue cycle tips are provided to reduce denied claims. Claim denials represent millions of dollars in lost and delayed net reimbursement annually. According to the American Medical Association (AMA), cost estimates of inefficient healthcare claims processing, payment, and reconciliation top out at $210 billion per year. Claim denials are so common, they’ve become a fixture […]
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Three Ways to Facilitate Better Decision-Making with Claims Automation

Suggestions for conducting peer-to-peer appeals for denials management. Claims Automation has been a part of the workers’ compensation and auto casualty industries for years, but today, a large opportunity still remains to increase in the claims automation process. The future of automation in the Property and Casualty industry is not to replace jobs but instead […]
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