Reinventing Claims Payment For A Value-Based World

Reinventing Claims Payment for a Value-Based World

  • June 6, 2017

Payers need to choose between automated payment and accurate automated payment 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…

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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

  • 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…

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Fixing Healthcare’s Broken Pre-Authorization Model

Fixing Healthcare’s Broken Pre-Authorization Model

  • November 28, 2016

Among the processes that influence the healthcare revenue cycle, pre-authorization stands out—and not in a good way! Most provider organizations are still managing pre-authorizations the old fashioned way: manually, with paper, pen, fax, and phone. These ad hoc methods of securing and confirming payer approval for non-emergency medical services are error-prone and inefficient, and often lead to denied or rejected claims or, worse, delays in service. Few organizations file claims manually any longer. Why, then, are we still completing, filing, and managing pre-authorization requests as if it's 1980? Technology advancements finally make it possible for providers to standardize and centralize…

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HealthLeaders Survey Reveals Pre-Auth Pain Points, Ways To Streamline Authorization

HealthLeaders Survey Reveals Pre-Auth Pain Points, Ways to Streamline Authorization

  • October 21, 2016

Pre-service authorization is a tedious, time consuming, and costly process for most providers. And issues related to pre-authorization are a major source of claims denials.

Those are just some of the pre-authorization pain points reported by HealthLeaders Media in a new survey of 158 senior clinical, operations, marketing, and financial leaders from non-profit and for-profit providers nationwide.

The study, commissioned by RelayHealth Financial, ranks pre-service authorization pain points and helps identify areas where improved processes and technology could help streamline payment and reduce denials.

Read the research

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Celebrating National Health IT Week

Celebrating National Health IT Week

  • September 26, 2016

In recognition of National Health IT Week, we've collected some of our most popular articles on healthcare payment innovation topics for you. Health IT innovation isn't just about technology. No matter how inventive a new technology is, it's only as effective as the people, processes, and policies that surround it. Technology alone doesn't solve problems. The people who use it do. For example, when reading From Silos to Services for Value-Based Care, you'll see how the technology itself wasn't particularly innovative -- it was "just" a database -- but the way the hospital's team designed and used it required breakthrough…

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The Interoperability Imperative

The Interoperability Imperative

  • September 19, 2016

Interoperability is a hot topic in HIT, with implications well beyond EHRs. Indeed, as payers and providers move from value-based pilots to full VBR, the industry is discovering that healthcare's transformation from fee-for-service to value-based care depends on HIT systems that can work together intelligently. We need to go beyond simple data exchange and brittle point-to-point connections to a future where HIT systems are seamlessly sharing intelligent services. In this article, Mike Wood, CIO of McKesson Health Solutions, explains how true interoperability can unlock silos in enterprise applications and connect the business logic needed to scale complex value-based reimbursement models…

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From Silos To Services For Value-Based Care

From Silos to Services for Value-Based Care

  • September 19, 2016

Value-based care. Bundled payment. Interoperable HIT systems. Contemporary topics, right? Not really. In fact, McKesson's Amy Larsson was at the forefront of these issues long before they joined the ranks of the hottest healthcare buzzwords. Some 25 years ago, Larsson was part of a team that developed what was arguably one of the first bundled payment programs -- and the team she worked with did it by hand, with a little help from a homegrown database. It wasn't perfect. It wasn't streamlined, fully automated, integrated, or interoperable. But it worked. That experience set her on a career path that ultimately…

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Don’t Be Denied At HFMA ANI 2016!

Don’t Be Denied at HFMA ANI 2016!

  • June 26, 2016

McKesson Health Solutions' Decision Management team will be at the 2016 Healthcare Financial Management Association National Institute (HFMA ANI 2016) in Las Vegas to share some unique tools and tips that can help your hospital reduce denials. Connect with us at booth 214 to see how you can use InterQual evidence-based criteria, coupled with some essential best practices, to help reduce denials related to medical necessity. If you can't make it to ANI this year, don't fret. We've just published several new resources that capture our recommendations and can help providers reduce medical necessity denials as well as improve their…

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Viva ANI!

Viva ANI!

  • June 25, 2016

If it’s June, it must be time for HFMA ANI 2016, when revenue cycle pros from across the country gather in Las Vegas to share experiences, learn from the best, and network with peers. And this year RelayHealth Financial has an agenda that has something for everyone. Here’s a quick summary of some of the events and sessions: Book Signing On Sunday evening, immediately following the opening keynote, come meet keynote speaker Julie Williamson, PhD, co-author of “Matter: Move Beyond the Competition, Create More Value, and Become the Obvious Choice.” She’ll sign free copies of the book in the RelayHealth Financial…

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Value-Based Payment Hits The Tipping Point

Value-Based Payment Hits the Tipping Point

  • June 13, 2016

Today, McKesson Health Solutions published new research pointing to continued growth of value-based reimbursement. Most noteworthy, payers surveyed said that 58% of their business has shifted to VBR, a remarkable increase from the 48% they reported in 2014. Read the news release

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