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 InfoIn one of the biggest attempts by the federal government to combat surprise medical billing, Congress in late 2020 passed the No Surprises Act (NSA), which imposes a host of new transparency and coverage requirements for employer-sponsored group...
More InfoYou’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...
More InfoThis is what providers can expect in 2022 in the form of new technology audits. During 2022, healthcare providers will see more options to exploit cyber technologies designed to aid them in management of Medicare audits. Below we review the...
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 InfoMost claims payments are now electronic, but providers can still realize millions in cost savings and reduce burden through true claims payment optimization. Claim payment is one of the most important steps in the claims management process...
More InfoBreak out your pen and paper because if you haven’t already started your list of new year’s resolutions, the past 12 months have given us plenty of ‘New Year, new me’ examples to take note of. From ratified legislation and appointed government...
More InfoProviders must rely on population health management strategies and effective risk stratification to succeed at value-based care. During the COVID-19 pandemic, organizations witnessed the consequences of fee-for-service as providers and patients...
More InfoUrgent care centers have assisted in the country’s COVID-19 response, but their value extends well beyond the pandemic. The past decade has witnessed a surge in the number of urgent care centers, with more than 9,000 of these...
More InfoAverage payments are $58,000 for small providers, $289,000 for medium providers, and $1.7 million for larger providers. The U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), said...
More InfoThe news coincided with the sudden worldwide emergence of the new omicron COVID-19 variant. An influx of cash couldn’t have come at a better time for the nation’s rural healthcare system. The U.S. Department of Health and Human Services...
More InfoThe payer will expand its partnership with Allina Health to cover more members under Medicare Advantage value-based contracts. “This value-based agreement for Humana Medicare Advantage members is an important part of helping our members achieve...
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