Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

Price Transparency May Lower $27 Billion in Healthcare

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Price transparency in the healthcare industry is becoming more and more pertinent and sought after. Research has shown that there is still insufficient price transparency within the medical field including hospital services. However, a new report...

How Health IT Automation Improves Consumer Satisfaction

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New technologies and health IT tools are becoming a necessary part of the health insurance industry, as innovative approaches like automation can largely benefit employees while portals could make a difference for health plan consumers. When...

4 Elements Necessary for Switching to ICD-10 Diagnosis Coding

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On October 1, 2015, the healthcare industry from payers and federal agencies to hospitals, physicians, and specialists transitioned to ICD-10 diagnosis coding. Many healthcare providers were concerned that their practices would not be prepared...

Value-based Care Reimbursement Makes Strides in Health Plans

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The fee-for-service payment model is slowly becoming an antiquated concept as more insurers and healthcare providers adopt value-based care reimbursement. Karen Ignani, President of Emblem Health and former CEO of America’s Health Insurance...

52% of Employers Offer High-Deductible Health Insurance Plans

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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 the...

Is Health Information Technology ‘Imperative for Payers’?

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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 privacy...

Healthcare Payment Reform May Need the Employer Perspective

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At the Healthcare Financial Management Association (HFMA) National Payment Innovation Summit taking place February 10 to 12 in Memphis, Tennessee, a multitude of stakeholders gathered to share ideas and innovations related to healthcare payment...

Do Provider Reimbursement Pathways Need Oncologist Perspective?

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When it comes to oncologists following a set protocol for cancer care, should health payers have a say in the type of pathways these physicians need to follow? An opinion piece from JAMA Oncology seems to say otherwise. The issue at hand is that,...

Cost Transparency, ‘Consumer-driven Healthcare’ Impacts Payers

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Cost transparency remains a vital aspect of healthcare reform among both providers and payers. Uninsured consumers and those who have employer-sponsored health coverage are continually finding the costs of premiums, deductibles, and general insurance...

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 Centene...

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 Brady,...

‘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 Medicaid...

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 private...

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 relatively...

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 US citizens...

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. The...

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 results...

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 administrator...

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 negotiated...

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 health...

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