One Medicare Advantage plan used the Ribbon tool to focus on quality measures and saw a 342% net increase in users achieving a 4+ star rating. Increased data transparency between health plans and providers on care and coding gaps results in...
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Medicaid expansion improved financial performance for healthcare providers and was associated with lower uncompensated care costs and higher revenues. Medicaid expansion has positively impacted healthcare providers by boosting financial...
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A recent survey highlighted how payment cuts are affecting denial strategies. Healthcare organizations are on the verge of stepping up their denials management strategies in 2023 as rate cuts are expected to impact revenue. On the delivery side...
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The number of prior authorization requests continues to increase — despite promises to the contrary by payers — costing physicians time and money. A Medical Group Management Association (MGMA) poll found that 70% of medical groups indicated that...
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You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your Electronic Health Record (EHR) system is excellent, the notes are voluminous, your providers are well-versed at coding. If anything...
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Payers have been wrongly cutting payments to physicians for evaluation-and-management (E/M) services—often automatically through the use of claim-editing algorithms. A new AMA resource helps physicians fight back against health insurer...
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Implementing and pursuing innovation in digital health and healthcare IT should be a priority for all U.S. healthcare providers and payers — especially as the lessons and response to the Covid-19 pandemic become permanently part of our everyday...
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The ED-ICU model has the potential to improve the value of healthcare delivery, as it has been shown to improve care quality and have little impact on emergency department costs. Total cost per emergency department (ED) patient encounter...
More InfoThe percentage of people covered by some type of health insurance in 2021 was higher compared to 2020, with public coverage rising significantly. It stands to reason that providers are treating more patients with health insurance. The percentage...
More InfoA survey shows that 60% of consumers who look for pricing information seek answers from their insurance companies, but healthcare price transparency should still be a priority for providers. Not many consumers are asking how much healthcare...
More InfoA new analysis shows that claim denial rates for in-network services among Healthcare.gov marketplace payers varied significantly, with some as high as 80%. Claim denial rates varied significantly among Healthcare.gov marketplace payers, with...
More InfoPayment integrity in Medicaid—the concerted effort to keep tight control over fraud, waste and abuse—can be addressed at any stage in the claim cycle. Of course, the earlier it is addressed, the easier it is for health plans to avoid improper...
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