Tag: Healthcare providers

Prior Authorization in Medicare Advantage

Prior Authorization in Medicare Advantage : Lawmakers Call for Streamlined Process

CMS has proposed a rule to simplify prior authorization in government-sponsored health insurance programs. However, some lawmakers are urging the agency to do more. A bipartisan coalition of 233 representatives and 61 senators have written a letter to CMS requesting that the proposed rules be expanded and that the changes be finalized quickly to enhance […]
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Adapting Risk Adjustment Coding

How Adapting Risk Adjustment Coding Can Change Healthcare Landscape?

Risk adjustment coding plays a vital role in the healthcare sector by capturing and documenting the severity of patient conditions. Its primary purpose is to guarantee precise reimbursement and risk adjustment scores. Given the ever-changing healthcare landscape, it is imperative for healthcare providers and coding professionals to remain adaptable and well-informed about the evolving requirements. […]
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Emerging Healthcare Technologies and Trends

Emerging Technologies and Trends Shaping the Future of Healthcare Tech

The healthcare industry is set to undergo a transformation with the emergence of various technologies and trends. From artificial intelligence, virtual reality, telehealth, to blockchain, the pace of innovation in healthcare tech is rapid and shows no signs of slowing down. In this article, we will explore some of the most promising technologies and trends […]
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Automating Claim Processing

Automating Claims Processing in the Healthcare Industry

By utilizing automation, it is feasible to improve the upstream and downstream adjudication process through data validation and routing. The healthcare industry can benefit from automation in almost all administrative functions, but it can significantly improve the auto-adjudication rate. In an ever-changing industry, possessing technical expertise is of utmost importance. The healthcare sector is increasingly […]
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AI in Healthcare with ChatGPT

Exploring the Potential of AI in Healthcare with ChatGPT

Since the launch of OpenAI’s ChatGPT last year, healthcare executives have been actively discussing the potential of artificial intelligence in healthcare. The technology is constantly advancing, and health systems are closely monitoring its applications for maximum benefits. Microsoft is said to be working on a healthcare-oriented version of ChatGPT that prioritizes privacy, and they have […]
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Pushing Back Against Medicare Advantage SNF Denials

Pushing Back Against Medicare Advantage SNF Denials: Part 1

Despite ongoing concerns about denials and beneficiary access to care, Medicare Advantage (MA) companies remain in the spotlight as their market penetration continues to grow. In April 2022, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) highlighted a significant issue in the capitated payment model employed […]
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Emerging Trends and Technologies For Healthcare Future

Future of Healthcare Technology: Emerging Trends and Technologies

The healthcare industry is on the brink of transformation, as a multitude of emerging technologies and trends, such as artificial intelligence, virtual reality, telehealth, and blockchain, are set to revolutionize it. The pace of innovation in healthcare technology is relentless and shows no signs of decelerating. A myriad of emerging technologies and trends, such as […]
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Tips to Optimize Cardiology Billing and Coding Process

Top Tips to Optimize Your Cardiology Billing and Coding Process

Cardiology Medical Billing and Coding Process: To effectively handle these changes, cardiology practitioners might have to keep themselves informed about the modifications in payment regulations, modify their billing procedures as needed, and employ novel methods to enhance their compensation. Cardiology billing and coding can be challenging due to various factors, such as the complexity of […]
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Updates to UnitedHealthcare's Reimbursement Policies

UnitedHealthcare Implements 9 Changes to Reimbursement Policies for May

On May 1, UnitedHealthcare made nine changes to its reimbursement policies for its commercial, individual and family, and Medicare Advantage plans. Some of the changes go into effect June 1, while others will begin August 1. Here are nine UnitedHealthcare reimbursement changes happening in the coming months: Commercial plans: Molecular pathology policy, professional and facility: […]
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