Thanks to the Affordable Care Act (ACA) patients have the right to appeal decisions made by their providers and by the insurers. The appeals process contributes to continuous improvement and greater efficiencies for all healthcare.
The CMS announced the redesign of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model. The two phase process will start in January of 2017 and continue for 5 years. Previous Medicare Advantage requirements have not incorporated...
A Managed Care Organization (MCO) utilizes an array of important techniques to decrease the cost of care. Transitioning to an MCO, the case study outlined here makes significant...
When it comes to revenue cycles, the amount of processes and subtleties involved are endless. Whether small or large all these steps impact the organization’s financial standing. It’s also easy to identify areas which...
Technology may be the answer to increasing doctor to doctor communication and eliminating avoidable medical errors. A new study published in JAMA International Medicine suggests that electronic medical records (EMR) and other important web-based tools can help decrease the occurrence of medical mishaps. The study analyzed how effective web-based tools were at enhancing communication, specifically during patient hand-offs.
Utilization management (UM) is crucial facet of the healthcare ecosystem. It ensures that healthcare systems are running efficiently and providing a standard level of care. Overall, utilization management is critical for ensuring that an organization is not only reducing denied claims, but catering to patients’ preferences and providing proper care.
Payers look to contractors for help as healthcare reform continues to drive change in the industry. From cutting costs to processing claims, there is an urgent need among payers for outsourcing. Claims management services are expected to see the biggest spike in growth in the coming years¹.
Hospital Readmissions penalties run high as the government plans to penalize more than half of the nation’s hospitals. Over the next year Medicare plans to withhold more than a half a billion dollars in payments, reports Kaiser Health news. In 2015 alone hospital readmissions penalties hit a total of $420 million¹.
The number of Accountable Care Organizations (ACOs) in the U.S. is growing rapidly, causing major shift in the healthcare landscape. ACOs are provider lead organization with a strong primary care base. What makes them different from other healthcare models is that ACOs are collectively accountable for quality, costs and the full continuum of care for their patients. Encouraged by the Affordable Care Act, this type of shared-risk model, which also falls under value-based, is becoming a good option for many providers.
Healthcare trends are crucial to watch, as they help organizations predict changes in the industry and can help then make critical improvements to the way they do business. In previous week's we looked at payer trends and payment trends. This week we are homing in on medical cost trends for 2017. From retail clinics to PBMs, there are many trends impacting healthcare spending.