A 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...
More InfoThis has, in turn, put greater emphasis on the need for Revenue Cycle Management (RCM) systems to enable a healthcare provider to better manage transactions between payer, provider and patients. It can, through the use of various software...
More InfoThe complexity around healthcare claims management is a major pain point for provider organizations, big and small. The increasing cost of claims coupled with a complex system of many payers, each with their own rules and requirements, creates...
More InfoAs part of its ongoing mission to improve the health of America, the Blue Cross Blue Shield Association (BCBSA) announced its National Health Equity Strategy in April 2021 to confront the nation’s crisis in racial health disparities. This...
More InfoHere are the six best reimbursement stories from 2021 HealthLeaders’ coverage and beyond. COVID-19 continued to impact healthcare reimbursement as the pandemic entered its second year. Yet, what’s different is that longer-term...
More InfoOver half of health systems also said they plan to advance risk-based payments or some form of capitation in commercial lines of business. The executive survey conducted by the Healthcare Financial Management Association (HFMA) for the Guidehouse...
More InfoThe pandemic has changed patients’ use and perceptions of healthcare organizations. The question remains: Will those changes here to stay? PATIENTS PREFER TELEHEALTH SERVICES FROM DOCTORS, HEALTH PLANS Most telehealth users accessed virtual...
More InfoAffordability, simplicity, and accessibility remain the three targets that payers aim to hit during Medicare open enrollment season, according to Christopher Ciano, president of Aetna Medicare. Listen to the full podcast to hear more details. And...
More InfoOrganizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working with population health management vendors, KLAS...
More InfoClaims management is a multi-step process that provides ample opportunity for errors and delays, but if payers modify their approach to certain steps in the process it could have a positive impact overall. In the most concise language, claims...
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