The 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...
More InfoThe COVID-19 relief bill the House passed Wednesday is a major win for various sectors in the healthcare industry, and includes the biggest update to the Affordable Care Act since it was enacted 11 years ago this month. The $1.9 trillion American...
More InfoThe COVID-19 pandemic continues to send more Utah residents to hospitals. Given the rise in hospital visits, addressing the need for cost transparency and clarity for patients has become more urgent than ever. Surprise Medical bills, a familiar...
More InfoPrior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers before...
More InfoDenied claims are one of physicians’ chief complaints when it comes to dealing with payers. To a certain extent, every practice deals with claim denials. It’s those practices that eliminate the most common reasons that experience a...
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