Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medical Billing

Emergency Air Ambulances Put Patients at Risk for Balance Billing

March 22, 2019 - Privately insured patients transported by emergency air ambulances outside their coverage networks are at high risk of balance billing, also known as surprise billing, according to a GAO report. Just under 70 percent of air ambulance transports conducted in 2017 were out-of-network, a significantly higher rate than other emergency services, the report found. Air ambulances provide...


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Payers, Providers, Lawmakers Debate Surprise Billing Guidelines

by Jessica Kent

State and federal policymakers are still considering various approaches to solve surprise billing issues and compensate out-of-network providers, including mandated values for reimbursement and independent dispute resolution, according to...

Senators Request Payer, Provider Data on Surprise Medical Billing

by Jessica Kent

Senators from both sides of the aisle have requested information from providers and payers regarding surprise medical billing. In a recently released letter, Senators Bill Cassidy (R-LA), Michael Bennet (D-CO), Todd Young (R-IN), Tom...

Retail Clinics, Surprise Bills Changing Healthcare Purchasing Patterns

by Jennifer Bresnick

Consumers are changing the way they spend their healthcare dollars as the stress of surprise medical bills, coupled with new retail-style options, change the care delivery landscape. Two new consumer surveys reveal that changing...

Healthcare Costs Vary Widely Across Geographic Regions

by Jesse Migneault

New research from the Health Care Cost Institute (HCCI) shows that healthcare costs for three common procedures, including knee injections, ACL repairs, and knee replacements, varied greatly across 61 metro areas.   The...

Top 5 Ways Commercial Payers Could Boost Consumer Engagement

by Vera Gruessner

Consumer engagement is an important factor that commercial healthcare payers may need to address in order to keep a loyal customer base throughout future open enrollment periods. Some health insurance companies have worked to address...

How Provider Portals Streamline Medical Claims Management

by Vera Gruessner

Healthcare payers have often struggled to process claims and provide effective customer service in a more streamlined manner due to technological inefficiencies. Insurers have faced challenges with engaging both their consumer base as well...

New York, California Enact Rulings Against Surprise Medical Bills

by Vera Gruessner

Healthcare payers may find that they may no longer have to pass on extraneous costs to their consumers when out-of-network providers send more costly claims their way. New legislation in states like New York and California may soon put an...

Veterans Affairs Processes Only 66% of Claims in 30 Days

by Vera Gruessner

The Medicare program, Medicaid coverage, and the Children's Health Insurance Program are not the only public payers offering  assistance to the American people. Veterans Affairs (VA) also ensures that those in the military receive...

Are Skilled Nursing Facilities Fraudulently Billing Medicare?

by Vera Gruessner

Skilled nursing facilities are an essential part of improving the health among the elderly and the disabled. However, some skilled nursing facilities and rehabilitation centers have taken advantage of Medicare beneficiaries by fraudulently...

13% of Midsize Employers Provide High-Deductible Health Plans

by Vera Gruessner

The health insurance industry has been changing due to the Affordable Care Act and other regulatory pressures from the Centers for Medicare & Medicaid Services (CMS). Rising healthcare costs along with the reforms taking place among...

Healthcare Cost Variation Differs Twofold between States

by Vera Gruessner

Those who have spent time in a doctor’s office or emergency room may have seen that the prices of healthcare services tend to vary drastically among separate medical facilities. New findings from the Health Care Cost Institute (HCCI)...

Is Rising US Healthcare Spending Burdening the Economy?

by Vera Gruessner

Is healthcare spending in the United States too high? Are the financial aspects of running the medical system around the country burdening the US economy? The National Center for Policy Analysis insists that the viewpoint claiming that...

64% of Polled Doctors Plagued by Rising Medical Spending

by Vera Gruessner

The health insurance industry needs to continue addressing rising healthcare costs and the increases in spending among hospitals and the pharmaceutical field. Many stakeholders within the healthcare space find that high rates of medical...

52% of Employers Offer High-Deductible Health Insurance Plans

by Vera Gruessner

Despite the fact that the health insurance exchanges and Medicaid expansion opened up more opportunities for Americans to obtain healthcare coverage without being dependent on employment, the health payer industry is still intertwined with...

Is Health Information Technology ‘Imperative for Payers’?

by Vera Gruessner

Health information technology remains a key aspect of maneuvering the health payer industry toward automating workflows and improving medical claims management. However, some insurers are still having difficulty with adhering to member...

How Paid Sick Leave Could Reduce Patients’ Financial Burden

by Vera Gruessner

One of the most looming issues within the healthcare industry has been the medical debt that many citizens around the nation incur if they are struck with a serious acute or chronic illness. A report published in the Journal of the...

85% of People with Expensive Copays Prefer Email Communication

by Vera Gruessner

One study stemming from Kaiser Permanente and published in The American Journal of Managed Care illustrated that one-third of patients who use email communication as their primary method of contacting their doctor reported better health....

How ICD-10 Diagnosis Coding Impacts HEDIS Quality Reporting

by Vera Gruessner

On October 1, 2015, healthcare providers and payers across the entire nation switched over to ICD-10 diagnosis coding and left the ICD-9 coding behind. Today the ICD-10 diagnosis coding system is being used for medical claims processing by...

How Total Cost of Care Transparency Aids Payment Reform

by Vera Gruessner

What’s the first step in addressing methods for reducing medical costs and strengthening healthcare delivery? Improving transparency behind healthcare spending as well as educating stakeholders in the financial aspects of the medical...

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