Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

Why Payers Need Robust Health Information Technology

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Health information technology continues to be an elusive field for the payer industry, as some insurers still have difficulty with adhering to key technological advancements and data security protocols. For example, the health insurer...

AHA Claims Stark Law Harms Value-based Care Reimbursement

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The American Hospital Association (AHA) has encouraged Congress, specifically the House Committee on Ways and Means, to put an end to regulatory obstacles standing in the way of value-based care reimbursement. In a letter sent to Chairmen...

‘Patient Voice’ Missing from Healthcare Spending Conversation

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Chronic disease continues to lead to heavy healthcare spending and health payers have aimed their sights on better understanding methods for preventing and addressing chronic medical conditions. Both private and public payers such as the...

Payers, Providers Use Population Health Management to Cut Costs

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Health payers and providers of today are working more closely together to develop effective care management strategies meant to reduce medical costs, improve quality of care, and ensure better patient health outcomes. For example, more...

Key Steps toward Affordable Health Insurance Platforms

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The average insured consumer is facing a whole new landscape when it comes to managing the costs of care. The prices surrounding health insurance plans and coverage options are rising steadily while wages and inflation rates remain...

Why a Competitive Health Insurance Plan Matters to Employees

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It seems that benefits and a health insurance plan majorly influence employment decisions of many Americans. An online survey completed by Harris Poll on behalf of the software company Collective Health shows that more than 75 percent of...

85% of People with Expensive Copays Prefer Email Communication

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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....

20% of Insured Americans Struggle with Paying Medical Bills

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A new report from Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation (EHF) shows that 3.8 percent fewer Texans found problems paying their medical bills in September 2015 when compared to the...

America’s Health Insurance Plans Loses Aetna Membership

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The major health payer Aetna has recently withdrawn its membership from one of the nation’s largest insurance lobbying group America’s Health Insurance Plans (AHIP). The lobbying group is now under new leadership. Former...

Health Payer Tips for Negotiating Managed Care Contracts

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With the medical industry focused on population health and the need to stabilize rising costs, it is no wonder that more healthcare providers and payers are negotiating managed care contracts. When these managed care contracts are...

How ICD-10 Diagnosis Coding Impacts HEDIS Quality Reporting

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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 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...

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...

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...

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...

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...

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...

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...

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,...

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...

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