Tag: Healthcare providers

Artificial Intelligence in RCM

How AI Can Create A Massive Competitive Advantage – 4 Financial Applications

Healthcare organizations have a tremendous opportunity to harness artificial intelligence in an area that may not seem flashy but is important nonetheless: revenue cycle management. Although 94 percent of companies firmly believe AI can give healthcare organizations a “massive competitive advantage,” according to Change Healthcare’s Adam Sullivan, PhD, less than 5 percent have extensively incorporated […]
Learn More
hhs-requests-hold-its-surprise-billing-appeal

Surprise Billing Fight Escalates As Providers Win Arbitration Add To House Bill

The House Energy and Commerce Committee passed the No Surprises Act with a provider-backed amendment adding an arbitration clause Wednesday afternoon. It will now head to the full House for consideration. Dive Brief: The House Energy and Commerce Committee is planning to add third-party arbitration to its surprise billing legislation, the No Surprises Act, on […]
Learn More
outpatient Medicare claims

CMS Delays OPPS Claim Edits For Off-Campus Provider-Based Depts

OPPS claim edits slated to take effect this month will now start in October to give providers more take to adjust to billing changes for off-campus provider-based departments. CMS is postponing the implementation of outpatient prospective payment system (OPPS) claim edits that would require hospitals and health systems with multiple locations to list provider addresses […]
Learn More
Chronic Care Management

How To Deliver Effective And Profitable Chronic Care Management

Chronic care management (CCM) has an overarching clinical goal—improving the health of Medicare patients with multiple chronic conditions. Besides knowing the service parameters, pay rates and usage requirements for CCM codes, physicians must understand how to effectively bill for CCM in order to profitably achieve that goal. Medicare pays for CCM (typically, non-face-to-face) services to […]
Learn More
Medicare Advantage

Medicare Advantage And The Future Of Value-Based Care

The Medicare Advantage (MA) program, which allows Medicare beneficiaries to voluntarily enroll in a private plan that administers health benefits, was established by the Balanced Budget Act (BBA) of 1997 as a vehicle to bring private-sector competition and innovation to Medicare beneficiaries. When the program was announced, the goal was to create greater competition on […]
Learn More
AI in healthcare

AI In Healthcare: Fact Or Fiction?

Patients experienced out-of-pocket increases as high as 12% for their healthcare costs last year, according to a new analysis by TransUnion Healthcare. Technology experts have promised artificial intelligence (AI) and machine learning (ML) will revolutionize healthcare. Applications have the potential to streamline workflows and reduce human errors, speeding drug discovery, assisting surgery, and provisioning better […]
Learn More
Medicare Advantage Plan

Medicare Advantage Plan Denials: Is That Convoluted or What?

Medicare Advantage Plan contracts are “take-it-or-leave-it” agreements Many questions are swirling about regarding Medicare Advantage Plan (MAP) denials asking what to do about the increasing number and given reasons.  I’ve heard or read some amazing stories where payers have gone to astounding lengths to deny claims.  Answers are also swirling about based on understandings of […]
Learn More
x