Two New Federal Interoperability Rules: What You Need To Know

Two New Federal Interoperability Rules: What You Need to Know

  • January 12, 2017

Federal agencies finalized two new rulings aimed at accelerating the pace of interoperability in health IT.  The ONC just released its 2017 Interoperability Standards Advisory and final rulings were made on MACRA. In the first of a series of white papers on interop policy, we review what these regulations mean for the industry. Taken together, the rulings demonstrate the government’s commitment to pushing the industry towards a fully open and connected health information infrastructure. Read now or download and read later  

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CMS To Continue Use Of InterQual Criteria

CMS to Continue Use of InterQual Criteria

  • December 19, 2016

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

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Put Prior-Auth On The Fast-Track

Put Prior-Auth on the Fast-Track

  • December 15, 2016

Everyone who thinks prior-authorization is a fast, efficient process, please raise your hand. No raised hands? No surprise. That’s because the prior auth process has been on the slow track for years, powered by paper, faxing, siloed software, and phone calls. Now payers can give provider networks a fast-track option for prior auth, where getting an authorization is as easy as requesting it through the payer’s care management portal. Payers like it because it reduces costs by freeing staff to tackle other things. Providers like it because it helps speed quality care. In fact, the only people who don’t like…

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From Silos To Services For Value-Based Care

From Silos to Services for Value-Based Care

  • September 19, 2016

Even though healthcare has spent decades automating processes and digitizing information, both remain remain largely locked in IT silos. There are impenetrable system boundaries between payers, providers, and vendors that reduce efficiency, increase costs, and resist automation. In other words, true interoperability is sorely lacking. From Silos to Services for Value-Based Care reviews the history of interoperability in healthcare and makes a case for how we can unlock the silos, bring information together, and align processes to improve clinical and financial outcomes. Read now or download and read later

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The Interoperability Imperative

The Interoperability Imperative

  • September 19, 2016

Interoperability in healthcare is not just about moving financial and clinical data between payer or provider or moving clinical data from one application to another. True interoperability allows enterprise applications to "talk" and collaborate in a smart, open, and agile manner. The Interoperability Imperative explains what this means; how and why interoperability is necessary to scale complex value-based reimbursement models; and how payers, providers, and vendors can get started. Read now or download and read later

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Ten Steps To Reduce Denials, Win More  Appeals, And Improve Hospital Performance

Ten Steps to Reduce Denials, Win More Appeals, and Improve Hospital Performance

  • June 24, 2016

Providers face tremendous pressure to reduce denials. Although many issues can lead to denials, there’s one area that denial management programs can easily overlook: issues related to medical necessity. This white paper focuses on 10 gaps that can cause medical necessity denials and how to address them, from beefing up emergency department case management to improving level of care management. Read now or download and read later

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Journey To Value: The State Of Value-Based Reimbursement In 2016

Journey to Value: The State of Value-Based Reimbursement in 2016

  • June 13, 2016

There's no turning back from value-based care and value-based reimbursement. Payers are 58% along the continuum to VBR, up from 48% in 2014. And Providers are now 50% down the road to value. That's according to a national study of 465 payers and hospitals conducted by ORC International and commissioned by McKesson. Yet despite tremendous growth in capitation/global payments, pay for performance, and episode of care/bundled payments, many payers and providers still face obstacles in the transition to value-based care. See where healthcare stands in its journey to value and what it means for the industry in Journey to Value: The State…

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McKesson Extends Contract With EQHealth

McKesson extends contract with eQHealth

  • December 7, 2015

Radiology and diagnostic imaging news site covered our recent customer news. We announced that eQHealth will use InterQual evidence-based clinical criteria for its state Medicaid contracts in Florida, Illinois, Mississippi, and Colorado, in addition to its other commercial lines. Read the full story

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