Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

How Care Management Strategies Could Reduce Medical Costs

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When it comes to managing the treatment and financial implications of complex medical conditions, health payers and providers will need to work together and have effective cross-industry communication. A strong relationship between payers and...

Value-based Care, Member Incentives May be Payers’ ‘Holy Grail’

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The healthcare payer industry is expected to change drastically over the coming years as more insurance companies adopt new business models and focus on value-based care. Moving away from fee-for-service, federal agencies and many payers are...

Mergers in Health Insurance Market Don’t Pose ‘Pure Monopoly’

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In recent months, four major players in the health insurance market have come together to form two separate mergers. The Aetna-Humana and Anthem-Cigna mergers have caused significant uproar among medical organizations that fear such a consolidation...

How Total Cost of Care Transparency Aids Payment Reform

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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 industry...

AMA, AHA Find Health Insurance Mergers Harmful to Consumers

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Many stakeholders are concerned about the potential implications of the Aetna and Humana acquisition along with the Anthem and Cigna merger. Having the top five major health insurers merge into only three payers could block access to affordable...

Health Insurance Mergers Expected to Bring Payer Concentration

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The health insurance industry is experiencing some significant transformations not only due to new policies under the Patient Protection and Affordable Care Act but also because of upcoming health insurance mergers among the nation’s top...

How Physician Home Care Lowers ER Visits and Healthcare Costs

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A common healthcare service provided to many patients with chronic medical conditions is the typical checkup from a visiting home nurse. One medical company called Heal is giving patients a step up from the nurse visit. Heal provides physician...

Top 4 Healthcare Insurance Trends to Expect in 2016

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As the year is coming to a close and many are getting ready to celebrate the holidays, it is important to look toward the coming year and prepare for healthcare insurance trends expected to impact the market. Over the last several years, both...

Soaring US Healthcare Spending Due to Technology, Drug Costs

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Before the Patient Protection and Affordable Care Act came into play, the United States was spending much more money on healthcare than many other first world countries. Despite high levels of US healthcare spending, our nation experiences worse...

Risk-Stratified Care Management Enables Customized Treatment

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Among health payers, one necessary strategy aimed at ensuring superior patient health outcomes is based on risk stratification and the data analytics behind this process. The American Academy of American Physicians defines risk-stratified care...

Claims Processing Found Successful after ICD-10 Transition

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Now that the ICD-10 transition has taken place across the country over the last month, the number of diagnosis codes has grown tremendously and many are wondering whether healthcare providers and payers will be able to successfully file claims...

CMS Reports Few Claim Rejections with ICD-10 Coding System

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On October 1 of this year, healthcare organizations including payers and providers around the nation switched over from ICD-9 coding to the new ICD-10 version for diagnostic coding. Along with affecting direct patient care, the ICD-10 coding...

How Providers can View Claim Status after ICD-10 Transition

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With hospitals, clinics, and health insurers moving fully into the ICD-10 transition over the last several weeks, it becomes imperative for providers and payers to determine whether their systems are working properly and reimbursement is on schedule....

State Workers’ Health Insurance Claims at Risk in Illinois

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Currently, there is a healthcare coverage crisis taking place for state employees in Illinois. CBS reports that the state of Illinois is having major complications related to keeping its budget intact. The state budget issues are impacting health...

How the ICD-10 Transition Deadline Changed the Nursing Role

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The October 1st ICD-10 transition deadline has passed and the healthcare industry still seems to be holding steady. However, only time will tell whether healthcare payers and providers were truly ready for the move to the new ICD-10...

More Time for Patient Care with Concierge Model of Medicine

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There are a wide variety of different payment models being implemented across the healthcare industry. Providers and payers are deciding which will provide the best quality of care while, at the same time, lowering costs. From free-for-service...

Will the Move to ICD-10 Medical Coding Delay Claims Processing?

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The health insurance space is about to have a major transformation in medical coding that could potentially cause financial barriers and claims processing issues. If the transition to ICD-10 medical coding is not properly managed, a variety of...

ICD-10 Implementation Deadline Affects Claims Processing

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Healthcare payers have a wide variety of concerns with regard to the coming ICD-10 implementation deadline and will need to be prepared for any potential issues that may pop up after the October 1, 2015 deadline. With a mere six days left, those...

3 ICD-10 Implementation Concentrations for Healthcare Payers

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As healthcare payers adjust their business models to more cleanly align with the continuously evolving ICD-10 landscape, immediate concern is being placed upon where payers should be focusing next as the healthcare industry...

Insurance Coverage Grows as Consumers Explore Payer Options

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Attitudes toward healthcare coverage and healthcare reform have been reshaped in recent years. New avenues of healthcare coverage have come to light, and they are opening more options for how consumers may receive their coverage. Between the...

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