Rethinking Denials Management

Rethinking Denials Management

  • March 16, 2017

Most provider organizations take an administrative approach to managing claim denials. Maybe that’s why they’re not collecting as much as they should. It turns out that most denial management programs have several flaws that, if corrected, can help close the gap on the 90% of claim denials that are preventable. This white paper explores a new holistic approach to denials management that intersects financial and clinical factors. See how some of the most prevalent causes of denials can be isolated and eliminated more effectively. Read now or download and read later

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Reinventing Claims Management For The Value-Based Era

Reinventing Claims Management for the Value-Based Era

  • February 17, 2017

Claim denials sap the life out of providers, leading to lost or delayed revenue, wasted time, and tons of frustration. And it's only getting worse as providers switch to more complex value-based payment models. To reduce denials, provider organizations need to evolve from putting out fires one denial at a time to a systemic approach that blends claims management and denials management into a holistic process. Doing so can have a significant impact on any provider organization’s bottom line. Learn more in this new paper, Reinventing Claims Management for the Value-Based Era. Read now or download and read later

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Patient Access And Revenue Cycle Analytics–Perfect Together, Yet Often Ignored

Patient Access and Revenue Cycle Analytics–Perfect Together, Yet Often Ignored

  • February 17, 2017

Providers don't usually think of patient access and revenue cycle analytics as a pair, but when you bring them together to guide process improvements, it can lead to significant savings -- potentially millions of dollars for a single facility. Here are just a few areas you can improve by pairing these to crucial pieces of the revenue cycle puzzle: Secure timely reimbursement from insurers and patients Reduce claims denials by drilling down to root causes Identify front-end registration and eligibility issues Learn more in this new guide, Patient Access and Revenue Cycle Analytics–Perfect Together, Yet Often Ignored. Read now or download and…

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Reinventing Utilization Management To Bring Value To The Point Of Care

Reinventing Utilization Management to Bring Value to the Point of Care

  • February 17, 2017

It's time to bring utilization management into the 21st century. A more collaborative, automated UM model could create a bridge between the current system, where authorizations happen after care decisions, and real-time communication between payers and providers that provides immediate decisions at the point of care. That bridge is what we call an "exception-based utilization management model." New technology can help payers identify which providers are getting approvals, for which care events, and how often. Then, using that knowledge, most care events can be automatically authorized, letting the payer limit their focus to the outliers. And even then, many of those…

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Four Steps To Develop, Implement, And Operationalize A Bundled Payment Strategy

Four Steps to Develop, Implement, and Operationalize a Bundled Payment Strategy

  • February 17, 2017

Health plans and hospitals see bundled payment as the fastest growing value-based payment model. They predict that the model will account for 17% of reimbursements in the next five years. But where do you begin? Start with this four-step guide, Bundled Payment 101: A Guide to Getting Started Quickly. The steps include analyzing data to identify episodes of interests, defining quality and savings targets, creating a transparent collaboration between payers and providers, and pulling it all together with a cloud-based claims analytics tool. Read now or download and read later

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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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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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Authorization Playing Catch Up With Technology

Authorization Playing Catch Up With Technology

  • September 1, 2016

Pre-authorization is time consuming, costly, can delay care, and is a major source of claims denials. Those are just a few of the pre-authorization pain points reported in a survey of C-suite provider executives nationwide. This white paper reports and ranks pre-authorization problems, delves into the issues, and provides a path forward  to improve pre-authorization to create more automated and streamlined system. Read now or download and read later

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Fixing Healthcare’s Broken Pre-Authorization Screening & Verification Model

Fixing Healthcare’s Broken Pre-Authorization Screening & Verification Model

  • June 27, 2016

Pre-authorizations can be costly, time-consuming, frustrating for all involved, and can account for a large percentage of denials. It's no surprise that health care networks are increasingly turning to technology to automate the process. Fixing Healthcare’s Broken Pre-Authorization Screening & Verification Model lays out how automation and other necessary components can transform the pre-auth process to be faster, more efficient, and more economical. Read now or download and read later

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