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6 Tips for Reducing Claims Denials

Optimizing your revenue cycle starts with reducing denials. In order to do this, you must have an effective Denial Management strategy in place. According to a new HIMSS Analytics study, 56% of hospitals surveyed said they don’t use a vendor solution for claim denials. However, around 60% of those respondents are planning on purchasing a claims denials management tool within the next year. If you are part of the 40%, now may be the time to think about investing in tools for claims denials.

Turn Your Denials Around: Denial Management Focus

Health insurance claim denials could be causing your organization to lose a significant amount of revenue each year. An effective Denial Management strategy is one of the fastest ways to recoup lost revenue, and ensure that you are being paid for the care that you are providing. Studies indicate that approximately 25-30% of healthcare claims are rejected or denied. This results in millions of dollars of lost revenue each year. The majority of these losses can be avoided by implementing our unique denial management process.

Value-Based Payment Models and the Future of Healthcare

The Centers for Medicare & Medicaid Services (CMS) has been pushing value based models that focus on quality of care rather than quantity. This means that most traditional incentive based payment models are being put phased out. The CMS hopes to tie 90% of all Medicare payments to alternative payment methods by 2018. Unlike fee-for-service models, value based models tie quality and cost together. By doing this they can encourage providers to give the best possible care at the best possible cost.

Telemedicine Battles Opioid Epidemic

The nation’s addiction to prescription painkillers is hovering at epidemic levels. The CDC reported that in 2014 more than 14,838 people died from overdoses of drugs such as oxycodone. (cite). Providers are now forced to think of new and innovative ways to help stop the epidemic, which is tied closely to the opioid epidemic. Telemedicine has become a huge savior for many rural areas trying to fight drug related deaths and conditions.

HEDIS Success & Value Based Care

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by 90% of the United States’ Health Plans to measure performance on important elements of care and service. HEDIS standardizes the way health plans collect, analyze, and report data. It creates an equal playing field for all health plans (who use HEDIS) to be compared. It also can be used by employers, consultants, and patients to find the best health plan match for their needs. Many payers are now using value based reimbursement models to help meet HEDIS benchmarks. These value based programs make providers accountable for closing gaps in care and meeting HEDIS measures.

Trend Watch: Behavioral Health Integration

Behavioral Health Integration has become one of the largest trends in healthcare this year. With one in 5 adults¹ experiencing a mental health condition each year, mental health can longer be pushed to the back burner. The demand for behavioral health services across the nation is sky rocketing, putting BH integration in an important position to help close gaps in care. It will take everyone from provider to payers breaking the stigma surrounding mental health and investing in ways to improve access to care and care outcomes.

NCQA Releases Health Insurance Plan Ratings for 2016

On September 22, 2016 the NCQA announced the release of the 2016-2017 Health Insurance Plan Ratings, this is the second year of the NCQA's new rating methodology. The Health Insurance Plan Ratings. which are published annually and compare the quality and services of more than 1,000 health plans across the United States. One new aspect of the 2016-2017 ratings is that WebMD will be publishing the ratings on their WebMD.com.

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