Tag: healthcare payers

Medical-Coding-Audits-Trends-and-Guide

Medical Coding Audits: Trends and Guide for Physicians

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, you under code! You provide excellent care for your patients and achieve great outcomes. No […]
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Payers-Wrongly-Cutting-Payments-To-Physicians-For-EM-Services

Payers Wrongly Cutting Payments To Physicians For E/M Services

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 downcoding. Downcoding happens when a payer changes a claim to a lower-cost service than what was submitted by the physician, leading the practice to get […]
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Digital-Health-and-Healthcare-IT-Post-Covid

The Future of Digital Health and Healthcare IT Post-Covid

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 lives. The outbreak of Covid-19 was a “black swan” event that dramatically accelerated the evolution and acceptance […]
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ED-ICU-Model-Improves-Value-of-Healthcare-Delivery

ED-ICU Model Improves Value of Healthcare Delivery

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 remained unchanged at an academic medical center after it implemented an emergency department-based intensive care unit (ED-ICU), […]
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Public-Coverage-Increase | Case Studies | AllZone Management Services Inc.

Uninsured Rate Falling as Public Coverage Increases

The 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 of people covered by some type of health insurance in 2021 was higher compared to the previous […]
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Healthcare-Price-Transparency

60% of Consumers seek Healthcare Price Transparency

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 services cost but among those who do, they are seeking answers primarily from their insurance companies, according to […]
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Claim-Denial-Rates-for-In-Network-Service

Claim Denial Rates as High as 80% for In-Network Services

A 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 some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family Foundation. Marketplace payers must […]
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Electronic Payment Key to Streamlining Healthcare Claims Management

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 administrative burdens and obstacles for providers. Ultimately, this complex system impacts the patient experience, as patients must […]
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