Payers and providers need efficient administrative services for profitability. With all the capital and human resources invested in electronic health records and data exchange security, why are documentation errors still one of the highest cause of adverse determinations? The number of claims slowed by lack of/incomplete/poor EHR documentation became crystal clear in recent reports.
The healthcare industry is undergoing an inevitable shift away from fee for service payment models towards reimbursement models that align with the healthcare triple aim, such as value based payments. The approach and question of which value-based model to implement still remains elusive for many organizations. Let’s take a look at some payment types on the value-based reimbursement spectrum.
Provider-sponsored health plans struggle through the ever-changing political environment. For providers hoping to get a handle on healthcare costs and supplement their own medical data with claims data, launching a health plan has been a strategic move.
The most important strategic security program decision that the organization can make is the framework that the organization adopts for its cyber-security and compliance program.
The era of volatile swings and double-digit growth in employer medical costs appears to be ending. With medical cost trend hovering in the single digits for several years, the industry has been waiting for the inflection point when spending will take off. But that spike appears unlikely to happen. The New Health Economy is settling into a “new normal,” typically characterized by more attenuated fluctuations and a single-digit trend.For four years, medical cost trend has hung between 6 and 7 percent, seeming to settle into a “new normal.” PwC’s Health Research Institute (HRI) anticipates a 6.5 percent growth rate for calendar year 2018, half a percentage point higher than in 2017.
Payers and providers connect, both formally and informally, through the reimbursement process. In past times, the relationships were stormy. Today, market forces push the need for better understanding of margin defense and revenue cycle performance. Streamlining internal operations addresses many of these new market demands. For example, patients demand higher value for care pushing more review of claims which push greater need for consistent documentation.
Over the past 40 years Health, United States provided an annual picture of the health of the United States, identified variations in health status, modifiable risk factors, and health care utilization among people by age, race and ethnicity, gender, income level, and geographic location. Examining long-term health trends inform the development and implementation of effective health policies and programs.
Behavioral health documentation is often the communication tool used by and between professionals. Records not properly documented with all relevant and important facts can prevent the next practitioner from furnishing sufficient services. The outcome can cause unintended complications.
The Senate released its version (a.k.a. Better Care Reconciliation Act BCRA) of the House's AHCA. Payers and providers adjust as needed because healthcare reforms, like BCRA, AHCA, and ACA, continuously move through state and federal legislatures. Today's blog, pulls together summaries from numerous resources allowing you a quick glimpse or a deep dive into what waits around the corner. Here are 10 instances which can help you better identify when its time to look for a partner.
Recruiting and retaining qualified Medical Directors and Chief Medical Officers challenge healthcare organizations of all types. Whether you employ or contract these medical professionals, consider two recent cases as reminders of potential issues far different than recruitment and retention and considerably more financially damaging. Significant risks beyond recruitment exist and staying informed about new Stark Law rulings pays.