How an automated exception-based approach can make UM more efficient and effective By Nilo Mehrabian How can health systems deliver the right care, at the right cost, in the right setting, without overwhelming delivery and reimbursement systems with administrative burden? The shift from volume to value-based care requires the deft combination of value-based delivery (enabled through actionable intelligence and new care delivery models) and value-based payment (enabled through select provider networks and new reimbursement models). Providers and payers must operate across a transparent, administratively simple, shared ecosystem. This giant leap from today’s world in which healthcare stakeholders currently operate might…
McKesson Technology Solutions and Change Healthcare have merged to create a new healthcare information technology company. The new Change Healthcare includes all of Change Healthcare's businesses and the majority of McKesson Technology Solutions, and will employ about 15,000 people. Read the article
Every provider would like prior auths to be faster and easier, so they can focus on delivering appropriate patient care instead of pushing paper. Now ZeOmega, developer of the Jiva population health management platform, has integrated InterQual Connect to help make automated authorizations a reality. In this new webinar, ZeOmega demonstrates how Jiva and InterQual Connect work together to streamline and automate auth requests, making exception-based UM a reality.
The prior-auth process has always been a challenge for providers: How to get approvals faster, so better care can go forward. Healthcare SaaS solutions innovator HealthTrio has integrated InterQual Connect into its Smart Connect portal to automate prior-authorization, resulting in faster auths and patient treatment. In this new webinar, see how nonprofit health plan CareOregon is using the solution to reduce manual work and speed appropriate patient care.
While more providers are taking advantage of technology to improve front-end revenue cycle processes, analytics lags behind. But when applied to patient access, analytics can help identify issues with registration and eligibility accuracy, and reduce downstream denials. A recent article in Multibriefs outlines the benefits of using analytics to improve patient-access processes in a value-based world. Read the Article
In the spirit of laughing at yourself (and the business), McKesson presented a series of cartoons at HIMSS17 that offer a lighter take on healthcare IT. Who says claims management is dry? Read the article
Why so serious? McKesson released some HIMSS17 humor to lighten the intensity of the annual HIMSS pilgrimage for HIT professionals. Read the article
On Monday at HIMSS17 in Orlando, RelayHealth Financial will unveil its new Healthy Hospital Index, an online service that allows hospitals to conduct a confidential assessment of their revenue cycle performance. Now, instead of trying to gauge financial performance in a vacuum–with no visibility into relevant national and regional KPIs and trends–financial executives can use Healthy Hospital’s analytics to benchmark their organization’s performance against that of peers. By simply entering some details about their revenue cycle performance, a customized “revenue health index” is generated with a comparative ranking of their hospital’s financial well-being. These insights can then be used to…
There's tremendous pressure on hospitals to reduce denial rates, and the problem is getting worse as claims processing becomes more complex. One way to reduce denials is to close common gaps that lead to medical necessity denials, which can account for as much as 5% of denials. CMSA Today shares a ten step process to that can have a quick and positive impact on your revenue cycle. Read the article
Today McKesson Health Solutions announced that the Centers for Medicare & Medicaid Services (CMS) will continue their long-term use of InterQual Criteria for Medicare services auditing programs. Extending a 17-year relationship, CMS will continue to benefit from InterQual's evidence-based clinical decision support to help better manage patients as the industry transitions to value-based care. Read the news release