Reinventing Claims Payment For A Value-Based World

Reinventing Claims Payment for a Value-Based World

  • June 6, 2017

By Amy Larsson RN, BSN, MBA The U.S. healthcare industry’s claims-payment system is frustrating to providers, payers, and patients alike. Inefficiency and a systemwide tendency for error wastes precious resources, worsens miscommunication and mistrust among all stakeholders, and inhibits the ability to transition to value-based approaches that achieve better outcomes. We need to rethink our industry’s disjointed and siloed approach in order to solve a very integrated problem. Despite billions invested in achieving efficient claims payment, more than 7% of claims are not paid correctly the first time, the second time, and sometimes even the third time¹. The remediation process…

Read More
Reinventing Utilization Management To Bring Value To The Point Of Care

Reinventing Utilization Management to Bring Value to the Point of Care

  • June 6, 2017

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…

Read More
Rethinking Denials Management

Rethinking Denials Management

  • March 16, 2017

Most organizations take an administrative approach to managing denials. Maybe that’s why they’re not collecting as much as they should. The Denials Challenge Few hospitals would admit to not having a denials management program, and yet as many as one in five claims for services already rendered are denied or delayed.1 Denials erode the provider organization’s bottom line, resulting in the permanent loss of an estimated 3% of net revenue.2 However, it’s not just the cost of the denials themselves, or the revenue lost–3% of the bottom line is significant no matter how it is sliced–it costs an average of…

Read More
Reinventing Claims Management For The Value-Based Era

Reinventing Claims Management for the Value-Based Era

  • February 17, 2017

Provider claims management as we once knew it is not enough to thrive in a value-based era. Here’s what you need to know about taking claims management to a higher level. By Carmen Deguzman Sessoms Provider claims management can no longer exist as a silo. With the rapid transformation from fee-for-service to value-based models, denial rates remain high–nearly 1 in 5 claims–despite advances in technology and automation.1 The complexity of value-based payment models almost guarantees an increase in denials, simply because there’s so much to get wrong. For provider CFOs and their organizations to be effective–and thrive–in this environment, the…

Read More
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

Why bringing analytics into patient access can radically improve a health system’s ability to get under the hood, understand what’s influencing financial performance, and improve the metrics that matter. By Jason Williams Some things go naturally together. Pen and paper. Thunder and lightning. Chocolate and peanut butter. And here’s a surprising one: patient access and revenue cycle analytics. You may have never thought of bringing the last two together, but no one thought of bringing chocolate and peanut butter together until it happened. Well, hospitals can make their revenue cycle much sweeter by applying revenue cycle analytics to improve patient…

Read More
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

By Andrei Gonzales, M.D. In the continuing effort to increase quality and decrease costs, health plans and providers are shifting from volume-based care (fee for service) to a value-based reimbursement structure (fee for value). Value-based reimbursement promises benefits to patients, providers, and health plans, as it encourages delivery of high quality care at the lowest cost, largely by improving clinical and administrative efficiency.¹ This paradigm shift to value-based reimbursement creates increasingly complex reimbursement scenarios for health plans. According to a “Journey to Value” study Change Healthcare commissioned, an overwhelming 97% of health plans and 91% of hospitals are now deploying…

Read More
Two New Federal Interoperability Rules: What You Need To Know

Two New Federal Interoperability Rules: What You Need to Know

  • January 12, 2017

By Lisa Conley Payers and providers are increasingly vocal about their need for health information technology (HIT) systems to interoperate in a consistent and industry-wide manner. While the industry has made progress on this front, recent actions in Washington aim to accelerate the pace of progress while also demonstrating the government’s commitment to HIT interoperability. On October 14th, 2016, the federal government announced two final regulations that impact the ongoing transformation to “full interoperability” in healthcare. One regulation was the nearly 2,400-page final rule from the Centers for Medicare and Medicaid Services (CMS) on implementation of the Medicare and CHIP…

Read More
From Silos To Services For Value-Based Care

From Silos to Services for Value-Based Care

  • September 19, 2016

A bundled payment program built by hand 25 years ago is still delivering lessons for HIT today By Amy Larsson The evolution of healthcare IT systems seen by industry visionaries sounds great. Siloed clinical and insurance systems get connected and can work as one. Information-rich processes flow smoothly and securely over connected services that span care settings, providers, and payers. We gain leaps in efficiency, quality, and accuracy of care coordination, delivery, and payment systems. And as healthcare evolves in its journey to value, we snap clinical and payment services together like the related pieces of the healthcare puzzle that…

Read More
The Interoperability Imperative

The Interoperability Imperative

  • September 19, 2016

How interoperability unlocks silos in enterprise applications and connects the business logic needed to support value-based reimbursement By Michael Wood Interoperability is about more than just moving data from one application to another. It’s about easily and seamlessly capitalizing on the business logic that is locked within separate—and often siloed—applications to create new capabilities that can solve business problems in a unique way. Today, interoperability must occur both within the four walls of a payer or provider’s IT infrastructure as well as within or between on-premise, off-premise, cloud, hybrid, and other hosting approaches in a manner that appears to be…

Read More
Authorization Playing Catch Up With Technology

Authorization Playing Catch Up With Technology

  • September 1, 2016

For as much as healthcare has been transformed by technology, there are still areas where it seems to be a game of catch up—such as obtaining pre-service authorization. While patients are becoming more involved in their own care, providers are increasingly incentivized to secure authorization from payers before procedures are performed to increase their likelihood of receiving payment. According to a June 2016 survey by HealthLeaders Media, pre-authorization is a consistent pain point that impacts leaders from the C-suite to operations and billing. A total of 158 surveys were completed by the Media Council, which consists of senior, clinical, operations,…

Read More
  • 1
  • 2